DESPITE improvements in patient selection and procedural techniques, researchers have identified that there has been a modest increase in risk-adjusted 30-day mortality rates following transcatheter aortic valve replacement (TAVR) between 2019 and 2022.
Researchers evaluated changes in TAVR outcomes between 2019 and 2022, a period in which mortality rates seemed to plateau despite ongoing advancements. It included 210,495 patients with severe aortic stenosis treated with TAVR across 786 U.S. hospitals, as recorded in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry. The primary outcome was 30-day mortality, with secondary outcomes including in-hospital mortality and composite adverse events. The goal was to determine if any factors could explain the observed trends in mortality rates.
Initial findings showed no significant changes in unadjusted 30-day mortality rates, with a trend from 2.4% in early 2019 to 2.2% by March 2022 (p = .10). However, after adjusting for patient characteristics, the odds ratio (OR) for mortality increased to 1.05 per year (95% CI, 1.02-1.08), and further adjustments for procedural characteristics increased this OR to 1.09 per year (95% CI, 1.05-1.13). Exploratory analyses examined several potential factors, including hospital volume, patient risk profiles, and procedural complications, but none significantly altered the adjusted odds of death.
The findings suggest that despite improvements in procedural methods and patient selection, there has been a small but concerning increase in mortality after TAVR. This underscores the need for ongoing monitoring of outcomes to prevent further rises in mortality. In clinical practice, this calls for a renewed focus on optimizing procedural techniques and patient care pathways, along with deeper investigations into underlying factors that may contribute to these trends. Further research is needed to explore other possible contributors to rising mortality, which may guide future clinical protocols.
Reference
Arnold SV et al. Trends in Transcatheter Aortic Valve Replacement Outcomes: Insights From the STS/ACC TVT Registry. JAMA Cardiol. 2024;DOI:10.1001/jamacardio.2024.3453.
