• Dhaval Kolte, Sahil Khera, Sreekanth Vemulapalli, Dadi Dai, Stephan Heo, Andrew M Goldsweig, Herbert D Aronow, Sammy Elmariah, Ignacio Inglessis, Igor F Palacios, Vinod H Thourani, Barry L Sharaf, Paul C Gordon, and J Dawn Abbott.
• Division of Cardiology, Brown University, Providence, Rhode Island.
• JACC Cardiovasc Interv. 2018 Jun 25; 11 (12): 1175-1185.

ObjectivesThe authors sought to examine outcomes and identify independent predictors of mortality among patients undergoing urgent/emergent transcatheter aortic valve replacement (TAVR).BackgroundData on urgent/emergent TAVR as a rescue therapy for decompensated severe aortic stenosis (AS) are limited.MethodsThe Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry linked with Centers for Medicare & Medicaid Services claims was used to identify patients who underwent urgent/emergent versus elective TAVR between November 2011 and June 2016. Outcomes assessed were device success rate, in-hospital major adverse events, and 30-day and 1-year mortality. Independent predictors of mortality after urgent/emergent TAVR were examined.ResultsOf 40,042 patients who underwent TAVR, 3,952 (9.9%) were urgent/emergent (median STS PROM score 11.8 [interquartile range: 7.6 to 17.9]). Device success rate was statistically lower, but not clinically different after urgent/emergent versus elective TAVR (92.6% vs. 93.7%; p = 0.007). Rates of major and/or life-threatening bleeding, major vascular complications, myocardial infarction, stroke, new permanent pacemaker placement, conversion to SAVR, and paravalvular regurgitation were similar between the 2 groups. Compared with elective TAVR, patients undergoing urgent/emergent TAVR had higher rates of acute kidney injury and/or new dialysis (8.2% vs. 4.2%; p < 0.001), 30-day mortality (8.7% vs. 4.3%, adjusted hazard ratio: 1.28, 95% confidence interval: 1.10 to 1.48), and 1-year mortality (29.1% vs. 17.5%, adjusted hazard ratio: 1.20, 95% confidence interval: 1.10 to 1.31). In patients undergoing urgent/emergent TAVR, non-femoral access and cardiopulmonary bypass were associated with increased risk, whereas use of balloon-expandable valve was associated with decreased risk of 30-day and 1-year mortality.ConclusionsUrgent/emergent TAVR is feasible with acceptable outcomes and may be a reasonable option in a selected group of patients with severe AS.Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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