Outcomes of Transcatheter Aortic Valve Replacement in Asymptomatic or Minimally Symptomatic Aortic Stenosis

• Published in: JACC. Cardiovascular interventions 2023-11, Vol.16 (21), p.2631-2641
• Main Authors: Huded, Chetan P, Arnold, Suzanne V, Cohen, David J, Manandhar, Pratik, Vemulapalli, Sreekanth, Saxon, John T, Chhatriwalla, Adnan K, Kosinski, Andrzej, Spertus, John A
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Female; Humans; Male; Risk Factors; Severity of Illness Index; Stroke Volume; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Ventricular Function, Left
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2023.07.007

Little is known about the outcomes of transcatheter aortic valve replacement (TAVR) in minimally symptomatic patients. The authors aimed to evaluate the outcomes of patients with minimally symptomatic severe aortic stenosis treated with TAVR in the STS/ACC TVT registry. Minimally symptomatic status was defined as a baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) ≥75. Clinical and health status outcomes of TAVR in patients with severe aortic stenosis and normal left ventricular ejection fraction were compared between minimally symptomatic patients and those with moderate or severe symptoms. Among 231,285 patients who underwent TAVR between 2015 and 2021 (median age 80.0 years [IQR: 74.0-86.0 years], 47.5% female), 20.0% were minimally symptomatic before TAVR. Survival at 1 year was higher in minimally symptomatic patients vs those with moderate or severe symptoms (adjusted HR for death: 0.70 [95% CI: 0.66-0.75]). Mean KCCQ-OS increased by 2.7 points (95% CI: 2.6-2.9 points) at 30 days and 3.8 points (95% CI: 3.6-4.0 points) at 1 year in minimally symptomatic patients compared with increases of 32.2 points (95% CI: 32.0-32.3 points) at 30 days and 34.9 points (95% CI: 34.7-35.0 points) at 1 year in more symptomatic patients. Minimally symptomatic patients had higher odds of being alive and well at 1 year (OR: 1.19 [95% CI: 1.16-1.23]). Although minimally symptomatic patients treated with TAVR experience only small improvements in health status, their overall outcomes are favorable with a higher likelihood of survival with good health status at 1 year compared with more symptomatic patients.