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Incidence, Predictors, and Outcomes of Major Transcatheter Aortic Valve Replacement (TAVR) Complications and Failure-to-Rescue in the Contemporary Era

Year: 2025

Type: article

Abstract: OBJECTIVES: As transcatheter aortic valve replacement (TAVR) expands to lower-risk populations, understanding contemporary patterns of complications requiring surgical intervention remains critical. This study examines the incidence, predictors, and outcomes of major TAVR complications. METHODS: The National Inpatient Sample (2016-2021) was queried to identify adult patients undergoing TAVR. Major complications were defined as surgical aortic valve replacement, coronary artery bypass grafting, aortic intervention, pericardial drainage, VA-ECMO, cardiac repair, or diagnosis of aortic dissection/rupture. Multivariable logistic regression identified predictors of complications and failure-to-rescue. RESULTS: Among 383 395 TAVRs, 4685 (1.2%) experienced major complications. Overall in-hospital mortality was 1.3%. Mortality was 26.0% in patients with major complications versus 1.0% without (P < .001). Stroke rates were also higher in patients with major complications (7.5% versus 1.8%, P < .001). Complications were associated with longer length of stay (8 vs 2 days) and higher hospital costs ($79,302 vs $45,469). Independent predictors of complications included age <65 (OR 2.27), bicuspid aortic valve (OR 1.79), thoracic aortic aneurysm (OR 1.49) and female sex (OR 1.24), while elective admission was protective (OR 0.51). Among patients with complications, VA-ECMO cannulation (OR 10.36), cardiac chamber repair (OR 3.14), and aortic dissection/rupture (OR 1.68) were strongest predictors of mortality. CONCLUSIONS: While the proportion of TAVR patients experiencing surgical emergencies has remained stable over time, the overall prevalence is increasing with the growth of TAVR, and these complications are associated with an in-hospital mortality rate of greater than 25%. Younger age, female sex, bicuspid valve, and thoracic aneurysm are associated with increased risk of major complications.

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivaf311