Elective Versus Urgent or Emergent Transcatheter Aortic Valve Replacement: A Retrospective Review of the TVT Registry

W. Lutfi¹, J. S. Giri², P. N. Fiorilli², H. C. Herrmann², N. J. Goel², A. Acker², M. Grasty³, R. H. Li², W. Szeto², N. D. Desai^2
1Department of General Surgery, University of Pennsylvania, Philadelphia, Pennsylvania ²University of Pennsylvania, Philadelphia, Pennsylvania ³Hospital of the University of Pennsylvania, Phialdelphia, Pennsylvania

Purpose: Few studies have attempted to compare the characteristics and outcomes of patients who undergo TAVR in the elective versus urgent and emergent setting. This study aims to achieve this goal using a retrospective review of the Transcatheter Valve Therapy (TVT) registry.

Methods: The TVT registry data contributed by a single academic hospital system involving two hospitals was queried. Patients who underwent TAVR from 2012 to 2023 were selected. Patients with missing documented indications for TAVR and those who had aborted procedures were excluded. Preoperative patient demographics, STS Short-Term Risk Score (STS-RS), 12 question Kansas City Cardiomyopathy Questionnaires (KCCQ-12), and inpatient complications and mortality were compared between patients who had elective TAVR versus urgent and emergent TAVR. Clinic visit follow-up KCCQ-12 scores were also compared. Mann-Whitney U-Tests and Chi squared tests were used.

Results: After selection, 4,567 TAVRs were included for analysis: 4,129 (90.5%) were elective, 422 (9.2%) were urgent, and 12 (0.3%) were emergent. 333 (7.3%) TAVRs were repeat valve-in-valve procedures. The median age was 81 years with an interquartile range of 76 to 81, 55.4% of patients were male. Median follow-up was 11 months. Table 1 shows the comparisons of demographics and outcomes between the three comparison groups. In comparison to elective TAVRs, urgent and emergent TAVR patients were younger, had higher STS risk scores, higher rates of valve-in-valve procedures, and lower preoperative KCCQ-12 scores. Rates of postoperative stroke were similar between the three groups. Postop mortality rates were 1.1% for elective, 3.3% for urgent, 16.7% for emergent TAVRs. Follow-up KCCQ-12 scores more similar among patients who survived their index operation.

Conclusion: In this retrospective review of elective versus urgent and emergent TAVRs, rates of perioperative mortality were significantly greater for urgent and emergent TAVRs. However, for survivors, quality of life as measured by KCCQ-12 scores are similar. These outcomes can help guide both patients and physicians as to the risks and potential benefits for patients being considered for urgent or emergent TAVR.

Identify the source of the funding for this research project: No funding sources.