P4267Incidence, predictive and prognostic factors of hospitalization for cardiac heart failure in patients implanted with TAVR

Abstract

Background: Transcatheter Aortic Valve Replacement (TAVR) is indicated in patients with symptomatic severe aortic stenosis in whom surgery is considered high-risk or contraindicated. Rehospitalization for congestive heart failure (CHF) after procedure remains a challenge and data on predictive and prognostic factors is lacking. Objectives: We sought to assess incidence, predictive and prognostic factors of rehospitalization for CHF in a population of patients with severe aortic stenosis treated by TAVR. Methods: All patients undergoing TAVR from January 2010 to December 2014 at our University Hospital have been included. Follow-up has been achieved for at least 1 year and included clinical, biological and echocardiographic data. Results: This report included 546 patients, 291 (53,3%) were female, mean age was 83.9±7.3 and mean logistic EuroSCORE was 15.6±10.9%. Among these patients, 534 (97,8%) have been implanted by a balloon-expandable valve and 482 (87.8%) by trans-femoral approach. At one year, hospitalization related to CHF and mortality rates were respectively 24.2% and 13.7%. Mortality rate was significantly higher in the group of patients re-hospitalized due to CHF (24.2% vs 10.4%, p<0.0001). By multivariate analysis, a low aortic mean gradient [HR=0.88; CI 95% (0.79-0.99); p=0.03], post-procedural blood transfusion [HR=2.27; CI 95% (1.13-5.56); p=0.009], severe post-procedural pulmonary hypertension [HR=1.04; CI 95% (1.00-1.07); p<0.0001] and left atrial dilatation [HR=1.47; CI 95% (1.08-2.01); p=0.02] were independently associated with CHF re-hospitalization at 1 year. Conclusion: Re-hospitalization for CHF after TAVR remains a frequent issue and is strongly associated with 1-year mortality.