Clinical Outcomes of Urgent or Emergency Transcatheter Aortic Valve Implantation　― Insights From the Nationwide Registry of Japan Transcatheter Valve Therapies ―

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  • Kitahara Hideki
    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
  • Kumamaru Hiraku
    Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo
  • Kohsaka Shun
    Department of Cardiology, Keio University School of Medicine
  • Yamashita Daichi
    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
  • Kanda Tomoyoshi
    Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
  • Matsuura Kaoru
    Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
  • Shimamura Kazuo
    Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
  • Matsumiya Goro
    Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
  • Kobayashi Yoshio
    Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine

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説明

<p>Background: Limited data are available for clinical outcomes in patients who underwent urgent or emergency transcatheter aortic valve implantation (TAVI). This study investigated in-hospital and 1-year outcomes and explored prognostic covariates in urgent/emergency TAVI using nationwide registry data.</p><p>Methods and Results: Among 26,775 patients who underwent TAVI between August 2013 and December 2019, 25,495 with 1-year follow-up information were analyzed in this study. Baseline and procedural characteristics, as well as clinical adverse events, were compared between the urgent/emergency and elective TAVI groups. The primary outcome was all-cause mortality within 1 year after TAVI. Multivariable Cox regression models were constructed to identify independent predictors after urgent or emergency TAVI. Urgent or emergency TAVI was performed in 578 (2.3%) patients. The Society of Thoracic Surgeons score was significantly higher in the urgent/emergency than elective TAVI group (13.3% vs. 6.0%; P<0.001). Device success rate was comparable between the 2 groups. All-cause death-free survival within 1 year was lower in the urgent/emergency than elective TAVI group (77.2% vs. 92.2%; log rank P<0.001). Malignancy, albumin and creatinine concentrations, ejection fraction, and mean pressure gradient were associated with 1-year mortality in the urgent/emergency TAVI group.</p><p>Conclusions: Despite higher surgical risk and more comorbidities, the procedure was successfully performed in patients undergoing urgent/emergency TAVI, although it should be noted that prognosis was worse than for elective TAVI.</p>

収録刊行物

  • Circulation Journal

    Circulation Journal 88 (4), 439-447, 2024-03-25

    一般社団法人 日本循環器学会

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