Outcomes of Procedural Complications in Transfemoral Transcatheter Aortic Valve Replacement

Abstract Objectives As the application of transcatheter aortic valve replacement (TAVR) expands, the longitudinal implications of peri-procedural complications are increasingly relevant. We examine the impact of TAVR complications on mid-term survival. Methods Patients undergoing transfemoral TAVR at our institution between November 2011 and June 2018 were reviewed. Stroke severity was classified according to the National Institutes of Health stroke score. Kaplan-Meier analysis was used to assess survival, and a Cox proportional hazards model was created to examine independent associations with survival. The median follow-up time was 36 months for a total of 2789 patient-years. Results Overall, 866 patients were included. The mean age was 80 years (±9.5) and mean STS score was 4.8% (±2.7). The mortality rate at 30-days was 2.8% and 11.8% at 1-year. In-hospital LBBB and 30-day permanent pacemaker insertion (PPM) occurred in 14.8% and 7.9%, respectively. Post-procedural greater-than-mild paravalvular leak (PVL) was present in 4.4% and stroke occurred in 3.8% at 30-days. Greater-than-mild PVL was associated with decreased survival at 2 years (p=0.02), but not at 5 years. Severe stroke was independently associated with decreased survival at 5-years (HR 5.73, 95% CI [2.29-14.36], p≤0.001), however the effect of non-severe stroke did not reach significance (HR 1.69, 95% CI [0.82-3.47], p=0.152). Conclusions Severe stroke was independently associated with decreased 5-year survival and initial risks associated with PVL may be attenuated over the mid-term following transfemoral TAVR. Strategies to minimize the incidence of stroke and PVL must be prioritized to improve longitudinal outcomes after TAVR.