Decompensated Aortic Stenosis: Time to TAVR Matters

Aortic stenosis prevalence is expected to increase in the coming years mainly driven by increased life expectancy. Patients will often find out when experiencing resting dyspnea, syncope, or signs and symptoms of acute deterioration, such as cardiac failure, referred to as acute decompensated aortic stenosis (ADAS). As we all know, optimal medical treatment in these cases is limited, with poor prognosis at hospital discharge, 30 days and one year. 

This analysis included 276 patients with ADAS; 150 received TAVR within ≤22 days after hospitalization and the rest, beyond this period. 

The primary outcome was hospitalization for cardiac failure or all-cause mortality.

The groups were comparable: mean patient age 84, 63% men, 53% hypertensive, 35% had coronary artery disease, 5% had PCI within 90 days prior TAVR, 26% had diabetes, 58% kidney function deterioration, 23% COPD and estimated glomerular filtration rate (eGFR) was 55 ml/min. Mean EuroSCORE was 6,5% and 3% required cardiopulmonary support.

Mean ejection fraction was 55%; 15% presented ejection fraction <30%. There were no differences in aortic valve area, gradients, velocity or presence of mitral or tricuspid regurgitation. 40% of patients presented stage >2 deterioration. 

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Mean time to TAVR was 14 days in ≤22 day patients and 33 days in the >22 group. 

There were no differences in valve type or hospital evolution. 

Patients were followed up to 4,6 (3,6–5,7) years. The primary outcome was seen in 58% of patients. Time to TAVR (for every 5-day delay) was significantly associated to the primary outcome (hazard ratio [HR], 1,09 [CI 95%, 1,03–1,14]; P=0,002). Also, >22 days to TAVR was associated to higher risk of adverse events (HR 1,48 [CI 95%, 1,09–2,03]; P=0,013).

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The was a significant link between the primary outcome and the presence of syncope, COPD, stroke, stage >2 and the need for cardiopulmonary support.

Conclusion

In patients with acute decompensated aortic stenosis, a longer wait to TAVR was associated to increased risk of events at mid-term. 

Original Title: Shorter Time to Transcatheter Aortic Valve Implantation Is Associated With Improved Outcomes in Acute Decompensated Aortic Stenosis.

Reference: Michael McKenna, et al. Circ Cardiovasc Interv. 2025;18:e014915. DOI: 10.1161/CIRCINTERVENTIONS.124.014915.