Impact of short-term complications of transcatheter aortic valve replacement on longer-term outcomes: results from the STS/ACC Transcatheter Valve Therapy Registry

Abstract

Abstract Aims While complications of transcatheter aortic valve replacement (TAVR) have decreased, they still occur commonly and may negatively impact both short- and long-term outcomes. We sought to examine the association of complications after TAVR with survival and health status in a real-world cohort. Methods and results Among 45 884 TAVR patients from 513 US sites who survived 30 days, 21.4% had at least one major complication [stroke, bleed, vascular complication, new pacemaker, acute kidney injury (AKI), and moderate/severe paravalvular leak (PVL)]. In multivariable models, Stage 3 AKI [hazard ratio (HR) 3.43, 95% confidence interval (CI) 2.64–4.45], stroke (HR 2.62, 95% CI 2.06–3.32), and bleeding (HR 1.83, 95% CI 1.55–2.16) were independently associated with significantly increased risk of early death (<3 months) with slight attenuation in these hazards between 3 and 12 months. Moderate/severe PVL (HR 1.37, 95% CI 1.21–1.55) and new pacemaker (HR 1.15, 95% CI 1.05–1.25) were associated with more modest risk of excess mortality that was consistent through 12 months. Among surviving patients, stroke (−6.1 points, 95% CI −8.4 to −3.7), moderate/severe PVL (−3.2 points, 95% CI −4.9 to −1.6), and new pacemaker (−2.3 points, 95% CI −3.2 to −1.5) were associated with less improvement in 1-year health status, as assessed by the Kansas City Cardiomyopathy Questionnaire. Conclusion In this study of contemporary TAVR, we found that complications remain common within the first 30 days after TAVR and are associated with worse 1-year survival and health status among survivors. These findings support continued efforts to reduce major complications of TAVR and may also help define quality of care.