Transcatheter aortic valve replacement (TAVR) has quickly consolidated as a safe and effective treatment option for patients with severe symptomatic aortic stenosis. At present, over 70,000 procedures are carried out every year in 700+ centers across the US. Technological advances, increased institutional and operator experience, and reduced risk profiles have all significantly contributed to TAVR outcomes.
However, the impact of changes in patient demographics and risk profile on cause of death (CdM) and cause-specific mortality after TAVR remains uncertain. Pivotal clinical trials have reported the proportion of cardiac or cardiovascular-related deaths at one-year post-procedure has ranged from 33.3% to 80.0% of total deaths. Meanwhile, CURRENT AS registry outcomes (Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe AS) have shown that, during an approximately 3-year followup, of 1,449 deaths in 3,815 patients with severe aortic stenosis, 55.3 % were attributed to cardiac cause and 44.7 % to non-cardiac cause. Infections and malignancies were the most common non-cardiac causes of death.
The aim of this registry was to look at cause of death and temporal trend predictors of cause-specific mortality after TAVR, as well as to identify factors associated to cardiac and non-cardiac deaths.
Primary end point was cause-specific death one year after TAVR, including in-hospital and discharge mortality.
36,877 patients were analyzed, mean age 82, mostly men. Mean STS was 6.8. Among the patients who died within one year of TAVR and for whom cause-of-death data were available, 11,560 (31.3%) died from cardiac causes and 25,317 (68.7%) from non-cardiac causes.
Initially, adjusted risks of cardiac and non-cardiac deaths at one year after TAVR declined between 2012 and 2017 (adjusted HR per year: 0,95 [CI 95 %: 0,92–0,97] and 0,92 [CI 95 %: 0,90–0,93], respectively), followed by an increase between 2018 and 2022 (adjusted HR per year: 1.07 [CI 95 %: 1.05–1.09] and 1.22 [CI 95 %: 1.20–1.24], respectively).
Independent predictors of cardiac and non-cardiac deaths were: >80 years, comorbidities, poor functional status, non-elective procedures, non-femoral approach and hospital complications.
Conclusion
Non cardiac causes represent most of deaths within the first year after TAVR. There was initial decline in risk-adjusted mortality rate, both cardiac and non-cardiac, between 2012 and 2018, followed by an increase between 2019 and 2022. Several non-modifiable factors (demographics, comorbidities) and modifiable (access site, hospital complications) were associated with higher risk of death at one year after TAVR.
Further study is required to fully understand the impact of the COVID-19 pandemic on TAVR outcomes at institutional and individual level in the US, also to be able to continue monitoring total and specific mortality trends in the post pandemic era.
Original Title: Temporal Trends in 1- Year Cause- Specific Mortality After TAVR Insights From the STS/ACC TVT Registry.
Reference: Dhaval Kolte, MD, PHD, MPH et al JACC Cardiovasc Interv. 2025.
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