Death after TAVR: New data support use of better patient assessments
Four percent of patients undergoing uncomplicated transcatheter aortic valve replacement (TAVR) die between 30 days and one year after treatment, according to new findings published in American Heart Journal.[1]
“The widespread adoption of TAVR reflects its high technical success rates, its less invasive nature compared with surgical aortic valve replacement and the steady reduction in major peri-procedural complications,” wrote first author Fabrizio D’Ascenzo, MD, PhD, an interventional cardiologist with the University of Turin in Italy, and colleagues. “Nevertheless, despite a seemingly uneventful procedural course and favorable short-term outcomes, a relevant proportion of patients experience adverse events within the first year after TAVR. In these cases, what may initially be judged as a ‘successful’ procedure could, in fact, be considered clinically futile—not because of valve-related failure, but due to inadequate patient selection, reduced physiological reserve, or the burden of systemic comorbidities.”
D’Ascenzo et al. reviewed data from more than 11,000 patients with a mean age of 82 years. Patients underwent treatment at one of 18 European sites from 2007 to 2022. Overall, 4% of those patients died between one and 12 months after treatment, despite experiencing no major complications post-surgery. A vast majority of those deaths (3.3%) were not at all related to cardiovascular causes.
The study’s secondary endpoint—deaths from one to six months after treatment—occurred in 2% of patients.
Independent predictors of death during this period of time included atrial fibrillation, chronic obstructive pulmonary disease, severe chronic kidney disease and a reduced left ventricular ejection fraction.
“The overall incidence of death between one and 12 months after uncomplicated TAVR was relatively low, indicating that the large majority of patients in this registry did not experience an adverse mid-term outcome after the procedure,” the authors wrote. “Accordingly, our findings should not be interpreted as suggesting that all patients who die within one year necessarily underwent a truly futile intervention, nor that TAVR programs should aim to minimize one-year mortality through increasingly restrictive patient selection. On the contrary, an excessively restrictive strategy could deny treatment to patients who may still derive meaningful symptomatic or prognostic benefit.”
Instead, the group added, the takeaway should be the potential benefits of better counseling before and after treatment. These findings may also provide value during shared decision-making conversations physicians have with their patients.
“In particular, the predominance of non-cardiovascular death highlights the need for a broader approach to candidate evaluation and follow-up, including pulmonary, renal, nutritional, and geriatric assessment and care,” the authors added.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.