Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure

Maina P. Jalava, Teemu Laakso, Marko Virtanen, Matti Niemelä, Tuomas Ahvenvaara, Tuomas Tauriainen, Pasi Maaranen, Annastiina Husso, Eeva Maija Kinnunen, Sebastian Dahlbacka, Jussi Jaakkola, Juhani Airaksinen, Vesa Anttila, Stefano Rosato, Paola D'Errigo, Mikko Savontaus, Mika Laine, Timo Mäkikallio, Antti Valtola, Peter RaivioMarkku Eskola, Fausto Biancari

Research output: Contribution to journalArticle

Abstract

Background: Patients with severe aortic stenosis and heart failure have poor prognosis, and their outcomes may be suboptimal even after transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Methods: This is an analysis of the nationwide FinnValve registry, which included patients who underwent primary TAVR or SAVR with a bioprothesis for aortic stenosis. We evaluated the outcome of patients with acute heart failure (AHF) within 60 days prior to TAVR or SAVR. Results: The prevalence of recent AHF was 11.4% (484 of 4241 patients) in the SAVR cohort and 11.3% (210 of 1855 patients) in the TAVR cohort. In the SAVR cohort, AHF was associated with lower 30-day survival (91.3% vs 97.0%; adjusted odds ratio 1.801, 95% confidence interval [CI] 1.125-2.882) and 5-year survival (64.0% vs 81.2%; adjusted hazard ratio 1.482, 95% CI 1.207-1.821). SAVR patients with AHF had higher risk of major bleeding, need of mechanical circulatory support, acute kidney injury, prolonged hospital stay, and composite end-point (30-day mortality, stroke and/or acute kidney injury). Patients with AHF had a trend toward lower 30-day survival (crude rates 95.2% vs 97.9%; adjusted odds ratio 2.028, 95% CI 0.908-4.529) as well as significantly lower 5-year survival (crude rates 45.3% vs 58.5%; adjusted hazard ratio 1.530, 95% CI 1.185-1.976) also after TAVR. AHF increased the risk of acute kidney injury, prolonged hospital stay, and composite end-point after TAVR. Conclusions: Recent AHF is associated with increased risk of mortality and morbidity after SAVR and TAVR. These findings suggest that aortic stenosis patients should be referred for invasive treatment before the development of clinically evident heart failure.

Original languageEnglish
Pages (from-to)110-117
Number of pages8
JournalAnnals of Thoracic Surgery
Volume109
Issue number1
DOIs
Publication statusPublished - Jan 2020

Keywords

  • trancatether
  • surgical aortic valve replacement
  • Acute heart failure

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Jalava, M. P., Laakso, T., Virtanen, M., Niemelä, M., Ahvenvaara, T., Tauriainen, T., Maaranen, P., Husso, A., Kinnunen, E. M., Dahlbacka, S., Jaakkola, J., Airaksinen, J., Anttila, V., Rosato, S., D'Errigo, P., Savontaus, M., Laine, M., Mäkikallio, T., Valtola, A., ... Biancari, F. (2020). Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure. Annals of Thoracic Surgery, 109(1), 110-117. https://doi.org/10.1016/j.athoracsur.2019.05.044