Transcatheter Aortic Valve Replacement Wait-list Failure-Correlation With Cardiac Damage Stage.

BACKGROUND

Waitlists for transcatheter aortic valve replacement (TAVR) are increasingly growing, universal criteria for prioritizing candidates are lacking, and some patients experience adverse events while awaiting the procedure. Aortic stenosis (AS)-related cardiac damage (CD) staging provides an echocardiographic framework for assessing structural CD in AS patients. We aimed to assess the correlation between CD staging and AS-related adverse events in patients awaiting TAVR.

METHODS

Waiting time for TAVR was assessed among patients with symptomatic severe AS, who were enrolled on our institutions' TAVR program during 2018-2022. The primary outcome was wait-list failure (WF), defined as AS-related hospitalizations or mortality during the waiting time for TAVR. Binary logistic regression multivariable analyses were performed to identify factors associated with WF before TAVR.

RESULTS

We included 904 AS patients (46.0% female; mean age 80.6 ± 6.8 years, mean Society of Thoracic Surgeons score 4.5 ± 2.7%). WF occurred in 72 patients (8.0%). Median waiting times were 53 (interquartile range, 35-79) days for TAVR, and 33 (interquartile range, 21-56) days until WF outcomes. Patients who experienced WF were older, with higher rates of frailty and comorbidities. On echocardiography, WF correlated with a higher CD stage. Multivariable analysis identified CD staging as an independent predictor of WF, as a continuous (hazard ratio, 1.66; 95% confidence interval, 1.15-2.42; P = 0.01) and a categorical variable (CD stage ≥ 3: hazard ratio, 2.24; 95% confidence interval, 1.07-4.71; P = 0.03). Additional predictors of WF were frailty and hypoalbuminemia.

CONCLUSIONS

Advanced CD stage is independently associated with unexpected hospitalizations and increased mortality during the waiting period for TAVR, underscoring its value in guiding candidate prioritization.