Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement

Francesco Saia, Azeem Latib, Cristina Ciuca, Valeria Gasparetto, Massimo Napodano, Alessandro Sticchi, Laura Anderlucci, Cinzia Marrozzini, Toru Naganuma, Ottavio Alfieri, Michela Facchin, Brunilda Hoxha, Carolina Moretti, Antonio Marzocchi, Antonio Colombo, Giuseppe Tarantini

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an effective therapeutic option for patients with severe aortic stenosis at high risk for surgery. Identification of causes of death after TAVR may help improve patient selection and outcome.

Methods: We enrolled 874 consecutive patients who underwent TAVR at 3 centers using all approved bioprostheses and different access routes. Clinical outcomes during follow-up were defined according to the Valve Academic Research Consortium 2 definitions. Causes of deaths were carefully investigated.

Results: Mean logistic European System for Cardiac Operative Risk Evaluation was 23.5% ± 15.3%; Society of Thoracic Surgery score, 9.0% ± 8.2%. The Corevalve (Medtronic, Minneapolis, MN) was used in 41.3%; the Edwards Sapien (Edwards Lifesciences Inc., Irvine, CA) in 57.3%. Vascular access was transfemoral in 75.7%. In-hospital mortality was 5.0%. Cumulative mortality rates at 1 to 3 years were 12.4%, 23.4%, and 31.5%, respectively. Landmark analysis showed a significantly higher incidence of cardiovascular (CV) death in the first 6 months of follow-up and a significantly higher incidence of non-CV death thereafter. At Cox regression analysis, the independent predictors of in-hospital mortality were acute kidney injury grades 2 to 3 (hazard ratio [HR] 3.41) life-threatening bleeding (HR 4.26), major bleeding (HR 4.61), and myocardial infarction (HR 3.89). The independent predictors of postdischarge mortality were chronic obstructive pulmonary disease (HR 1.48), left ventricular ejection fraction at discharge (HR 0.98), and glomerular filtration rate 2 (HR 1.64).

Conclusions: Around a third of patients treated with TAVR in daily practice die within the first 3 years of follow-up. Early mortality is predominantly CV, whereas late mortality is mainly non-CV, and it is often due to preexisting comorbidity.

Original languageEnglish
Pages (from-to)798-806
Number of pages9
JournalAmerican Heart Journal
Volume168
Issue number5
DOIs
Publication statusPublished - Nov 1 2014

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Cause of Death
Mortality
Hospital Mortality
Hemorrhage
Bioprosthesis
Aortic Valve Stenosis
Incidence
Glomerular Filtration Rate
Acute Kidney Injury
Stroke Volume
Chronic Obstructive Pulmonary Disease
Patient Selection
Thoracic Surgery
Blood Vessels
Comorbidity
Myocardial Infarction
Regression Analysis
Transcatheter Aortic Valve Replacement
Research
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Saia, F., Latib, A., Ciuca, C., Gasparetto, V., Napodano, M., Sticchi, A., ... Tarantini, G. (2014). Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement. American Heart Journal, 168(5), 798-806. https://doi.org/10.1016/j.ahj.2014.07.023

Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement. / Saia, Francesco; Latib, Azeem; Ciuca, Cristina; Gasparetto, Valeria; Napodano, Massimo; Sticchi, Alessandro; Anderlucci, Laura; Marrozzini, Cinzia; Naganuma, Toru; Alfieri, Ottavio; Facchin, Michela; Hoxha, Brunilda; Moretti, Carolina; Marzocchi, Antonio; Colombo, Antonio; Tarantini, Giuseppe.

In: American Heart Journal, Vol. 168, No. 5, 01.11.2014, p. 798-806.

Research output: Contribution to journalArticle

Saia, F, Latib, A, Ciuca, C, Gasparetto, V, Napodano, M, Sticchi, A, Anderlucci, L, Marrozzini, C, Naganuma, T, Alfieri, O, Facchin, M, Hoxha, B, Moretti, C, Marzocchi, A, Colombo, A & Tarantini, G 2014, 'Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement', American Heart Journal, vol. 168, no. 5, pp. 798-806. https://doi.org/10.1016/j.ahj.2014.07.023
Saia, Francesco ; Latib, Azeem ; Ciuca, Cristina ; Gasparetto, Valeria ; Napodano, Massimo ; Sticchi, Alessandro ; Anderlucci, Laura ; Marrozzini, Cinzia ; Naganuma, Toru ; Alfieri, Ottavio ; Facchin, Michela ; Hoxha, Brunilda ; Moretti, Carolina ; Marzocchi, Antonio ; Colombo, Antonio ; Tarantini, Giuseppe. / Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement. In: American Heart Journal. 2014 ; Vol. 168, No. 5. pp. 798-806.
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AU - Saia, Francesco

AU - Latib, Azeem

AU - Ciuca, Cristina

AU - Gasparetto, Valeria

AU - Napodano, Massimo

AU - Sticchi, Alessandro

AU - Anderlucci, Laura

AU - Marrozzini, Cinzia

AU - Naganuma, Toru

AU - Alfieri, Ottavio

AU - Facchin, Michela

AU - Hoxha, Brunilda

AU - Moretti, Carolina

AU - Marzocchi, Antonio

AU - Colombo, Antonio

AU - Tarantini, Giuseppe

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