- Email: [email protected]
TCT-143 Impact of Frailty Markers For Unplanned Hospital Readmission Following Transcatheter Aortic Valve Implantation
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
were delivered to the right side of the interventricular septum. An external anchor was fitted onto a tether to allow apposition of the LV free wall to the scarred septum.
TCT-142 Prognostic value of heart failure before and during the first year after TAVI. Factors determining heart failure after TAVI
RESULTS 89 patients were treated from August 2010 till March 2016. Baseline EF was 308%, LVESVI was 7026 ml/m2, and LVEDVI was 9531 ml/m2. Four patients (4.5%) died in-hospital and 1 (1.1%) had a stroke. Two-year survival was 87%. In 35 patients who have completed 2-year echo follow up, EF improved by 19%, LVESVI reduced by 31%, and LVEDVI reduced by 21%. NYHA class reduced from 2.60.5 to 1.80.7 (p<0,001), 6-minute walk test increased from 37282 minutes to 42594 minutes (p¼0.002), and Minnesota Living with Heart Failure score reduced from 4421 to 2720 (p<0.001). Serial echocardiograms and functional evaluations at 6, 12, and 24 months demonstrated sustained improvements.
Diego López Otero,1 Diego Iglesias Alvarez,2 Pablo José Antúnez Muiños,3 José Ramón González Juanatey3 1 Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; 2Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; 3Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
CONCLUSION Sustained improvement of echocardiographic and functional parameters and excellent survival are obtained with the Less Invasive Ventricular Enhancement technique. In patients with no significant MR and/or myocardial ischemia, ventricular reduction and reshaping, when performed off-pump using the Revivent myocardial anchors, demonstrates long term decrease in heart failure symptoms. CATEGORIES STRUCTURAL: Heart Failure TCT-141 Changes in Left Ventricular Ejection Fraction after Transcatheter Aortic Valve Replacement John Broderick,1 Adam Magier,1 Dean Kereiakes,1 Ian Sarembock,1 Joseph Choo,1 Cheryl Bartone,1 Eugene Chung1 1 The Christ Hospital, Cincinnati, Ohio, United States BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the primary method of aortic valve replacement for intermediatea and high surgical risk patients with aortic stenosis (AS). While prior data support a general rise in EF after TAVR, the relationship between baseline EF and change after TAVR are not well characterized. Accordingly, we evaluated the change in EF and mortality for patients undergoing TAVR in a single center registry. METHODS In 192 patients, Simpson’s biplane EF was measured from echocardiograms obtained at baseline, 1 and 12 months. Patients were stratified according to baseline EF: <40, 40-50 and >50 %; changes in EF at 1 and 12 months are shown (figure). RESULTS Compared with baseline, the average overall EF was 4.7% units greater at 1 mo and 2.5% units at 12 mo. The EF <40 group had a significant increase in EF at each follow up, while the >50 group had a reduction. The 40-50 % EF group did not change in follow up. Further, patients whose EF increased > 10% between BL and 1 mo (average baseline EF ¼ 41%), had a trend toward lower 1-year mortality compared to all other patients (average baseline EF ¼ 55%) (6% vs 15% respectively, p¼0.12).
BACKGROUND To determine if previous admission due to heart failure (HF) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) has a prognostic value in terms of mortality or rehospitalization due to heart failure (rHF) during the first year after TAVI. METHODS Retrospective study involving 349 patients undergoing TAVI. HF was defined according to the ESC guidelines. Pro B-type natriuretic peptide (pro-BNP) was determined in all patients 24 hours before TAVI and 3 months after implantation. Pro-BNP levels were transformed to logarithm to homogenize the sample (log pro-BNP). We analyzed the association between HF and clinical events after TAVI using multivariable logistic regression models. RESULTS The mean age of the population was 82.4 5.7 years, 56% women, with a mean logistic EuroScore of 18.39 10.9% and STS score of 5.9 3.8%.The mean pro-BNP before TAVI was 5051 14661 pg/mL (mean log pro-BNP 3.3 0.51) and at 3 months, 2648 8809 pg/mL (mean log pro-BNP at 3 months 3.02 0.52). 56.7% (n¼198) of the patients had previous admission for HF and 10% (n¼35) of patients had rHF during the first year after TAVI. There was no significant association between the previous HF and rHF during the first year with mortality at follow-up (709 492 days). The results of the multivariate analysis showed that previous HF admission [HR ¼ 4.1; 95% CI, 1.3-13.0; P ¼ 0.016] and high levels of log pro-BNP 3 months after implantation, [HR ¼ 4.4; 95% CI, 1.2-15.4; P ¼ 0.019], were associated with rHF in the first year after TAVI (after adjustment by age, logistic EuroScore, LVEF and log pro-BNP before implantation). CONCLUSION TAVI reduces dramatically the number of heart failure admissions. History HF, previous to TAVI, and rHF, during the first year after TAVI, are not associated with higher mortality rate in the followup. Log pro-BNP at three months after TAVI and previous HF admission are independent predictors of rHF during the first year after TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic HIGH RISK PATIENTS AND TAVR - I
Abstract nos: 143 - 147 TCT-143 Impact of Frailty Markers For Unplanned Hospital Readmission Following Transcatheter Aortic Valve Implantation Mike Saji,1 Ryosuke Higuchi,1 Kenichi Hagiya,2 Itaru Takamisawa,1 Tetsuya Tobaru,1 Nobuo Iguchi,1 Shuichiro Takanashi,2 Morimasa Takayama,2 Mitsuaki Isobe1 1 Sakakibara Heart Institute, Tokyo, Japan; 2Sakakibara Heart Institute, Fuchu, Japan BACKGROUND Frailty has become a major theme in cardiovascular diseases due to the aging population. Recently, variable frailty markers have been developed to guide better patient selection in transcatheter aortic valve implantation (TAVI). This study aimed to investigate the timing, and specific causes of unplanned hospital readmission after initial hospitalization with TAVI, and to investigate which frailty markers could better predict unplanned readmission.
CONCLUSION In a large consecutive patient cohort undergoing TAVR, baseline EF is inversely correlated with change in EF at early and late follow-up. Further, short-term rise in EF may be associated with lower mortality despite higher baseline risk profile (lower baseline EF). The relationship between baseline EF, rapid change in afterload, and subsequent structural and functional responses warrant further study. CATEGORIES STRUCTURAL: Heart Failure
METHODS We retrospectively reviewed 155 patients who underwent TAVI. Although unplanned readmission <30days was 1.9%, quarter of patients had unplanned readmission following TAVI within a year mainly due to heart failure and pneumonia. Short physical-performance battery (SPPB), Placement of AoRTic TraNscathetER Valve (PARTNER) frailty scale, frailty index, clinical frailty scale, modified Fried scale, and gait speed were calculated. The primary endpoints was unplanned hospital readmission following TAVI. Each frailty marker was entered into a multivariate model in addition to variables with p-values <0.25 in a univariate analysis.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
RESULTS With 479 319 days, 64 (41%) patients had unplanned readmission following TAVI. Only three patients (1.9%) required unplanned readmission less than 30 days. Of 64 admissions, 27 were due to cardiac causes, while 37 were noncardiac causes. Of 27 admissions with cardiac reason, 16 (59%) were due to heart failure, while 37 admissions with noncardiac reason, 21 (56%) were due to infection. All frailty markers but the modified Fried scale were found to be independently associated with primary endpoints after adjustment in multivariate analysis. Other independent predictors in multivariate analysis were atrial fibrillation, chronic obstructive pulmonary disease, hemoglobin <11g/dL, estimated gromerular filtration rate (every 15 ml/1.73m2 decrease), and albumin. Furthermore, in receiver operating characteristic analysis, the SPPB had the highest discriminatory performance for predicting primary endpoint (area under the curve 0.71, 95% confidence interval 0.60–0.80, p <0.001). CONCLUSION Precise geriatric assessment is crucial following TAVI as well as index hospitalization in this frail population. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-144 High Pulmonary Vascular Resistance is Associated with Higher Mortality in Transcatheter Aortic Valve Replacement Patients with Pulmonary Hypertension Gavin Hickey,1 Dustin Kliner,2 Jeffrey Xu,3 Floyd Thoma,2 Andrew Althouse,2 Joon Lee,2 John Schindler,2 Thomas Gleason,3 Joao Cavalcante4 1 UPMC, Pittsburgh, Pennsylvania, United States; 2University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; 3 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States; 4University of Pittsburgh/UPMC, Pittsburgh, Pennsylvania, United States BACKGROUND Pulmonary hypertension (PH) is common in patients with severe aortic stenosis treated with transcatheter aortic valve replacement (TAVR). Though PH in this population is primarily driven by elevated left-sided pressure (post-capillary PH), some patients have increased pulmonary vascular resistance (PVR), thus combined pre- and post-capillary PH. We sought to determine if increased PVR in PH patients undergoing TAVR would be associated with increased mortality when compared to those with normal pulmonary pressure, or elevated pulmonary artery pressure and normal PVR.
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CONCLUSION TAVR patients with PH and high PVR have the highest mortality, moreso than those with PH and normal PVR, or without PH. Therefore, PVR provides additional risk stratification in TAVR patients with PH. Use of RHC prior to TAVR may provide useful insight into long-term outcome. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-145 Influence of Cachexia on Mortality after Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Valve Stenosis Lisa Voigtländer,1 Florian Deuschl,1 Niklas Schofer,1 Nicole Rübsamen,1 Moritz Seiffert,1 Daniel Kalbacher,1 Yvonne Schneeberger,1 Johannes Schirmer,1 Hermann Reichenspurner,1 Stefan Blankenberg,1 Lenard Conradi,1 Ulrich Schäfer1 1 University Heart Center Hamburg, Hamburg, Germany BACKGROUND Cachexia is a serious complication of chronic illness, which is associated with a poor prognosis. The patient population undergoing transcatheter aortic valve implantation (TAVI) is, according to the risk selection criteria, in a higher age and with a higher prevalence of comorbidities and chronic illness.The objectives of the study were (i) to determine the prevalence of cachexia and (ii) to examine the prognostic impact of body wasting on short- and longterm-mortality after TAVI. The objectives of the study were (i) to determine the prevalence of cachexia and (ii) to examine the prognostic impact of body wasting on short- and longterm-mortality after TAVI. METHODS Between 2008 and 2014 1045 patients (mean age 80,28.9; mean LogES 20.712.3) with body mass index (BMI)<30 kg/m2 were treated by TAVI in our institution. Patients with BMI>30 kg/m2 were excluded of the study (n¼206).78 (7.5%) of these patients had a BMI<20 kg/m2 and 23 (2.2%) had a BMI<18 kg/m2. BMI<20 kg/m2 was defined as moderate cachexia and BMI<18 kg/m2 as severe cachexia. RESULTS Overall 30-day mortality was 9.2% and 12-month mortality was 26.8%. Patients with cachexia had an increased mortality at 30 days (moderate cachexia: 19.2%; severe cachexia: 38.5%; p1¼0.012; p2<0.001) and at 12 month (moderate cachexia: 30.4%; severe cachexia: 60.9%; p1¼0.009; p2<0.001) (Figure 1). Furthermore, ROC-analysis showed, that BMI<23.7 is associated with an increased mortality.
METHODS We performed a retrospective study of 439 patients treated at a single center who had right heart catheterization (RHC) prior to TAVR. PH was defined as a mean pulmonary artery pressure (mPAP) 25 mmHg. We report the frequency of PH as well as the proportion with PVR 3 Wood units (WU). Kaplan-Meier analysis and Cox proportional-hazards regression were used to quantify the effect of high PVR on subsequent mortality within the PH population. RESULTS Of the 439 patients with baseline RHC, 305 (70%) had PH prior to TAVR, of which 122 (40%) had PVR 3 WU. After adjustment for baseline characteristics using STS-PROM score, TAVR patients with PH and PVR3 had the highest mortality (HR¼1.58, 95% CI 0.95-2.64, p¼0.079), while patients with PH and PVR<3 had only slightly increased mortality (HR¼1.04, 95% CI 0.62-1.75, p¼0.865).
CONCLUSION Cachexia in patients undergoing TAVI is associated with an increased mortality. Especially patients with BMI<18 demonstrated an excess mortality after 30 days and 12 month. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-146 The impact of clinical frailty on one-year mortality post transcatheter aortic valve replacement M. Chadi Alraies,1 Homam Moussa Pacha,2 Elizabeth Bond,1 Kyle Buchanan,3 Toby Rogers,1 Edward Koifman,1 Arie Steinvil,4 Petros Okubagzi,1 Linzhi Xu,1 Rebecca Torguson,3 Itsik Ben-Dor,5 Augusto Pichard,3 Lowell Satler,3 Ron Waksman5
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
were delivered to the right side of the interventricular septum. An external anchor was fitted onto a tether to allow apposition of the LV free wall to the scarred septum.
TCT-142 Prognostic value of heart failure before and during the first year after TAVI. Factors determining heart failure after TAVI
RESULTS 89 patients were treated from August 2010 till March 2016. Baseline EF was 308%, LVESVI was 7026 ml/m2, and LVEDVI was 9531 ml/m2. Four patients (4.5%) died in-hospital and 1 (1.1%) had a stroke. Two-year survival was 87%. In 35 patients who have completed 2-year echo follow up, EF improved by 19%, LVESVI reduced by 31%, and LVEDVI reduced by 21%. NYHA class reduced from 2.60.5 to 1.80.7 (p<0,001), 6-minute walk test increased from 37282 minutes to 42594 minutes (p¼0.002), and Minnesota Living with Heart Failure score reduced from 4421 to 2720 (p<0.001). Serial echocardiograms and functional evaluations at 6, 12, and 24 months demonstrated sustained improvements.
Diego López Otero,1 Diego Iglesias Alvarez,2 Pablo José Antúnez Muiños,3 José Ramón González Juanatey3 1 Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain; 2Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; 3Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
CONCLUSION Sustained improvement of echocardiographic and functional parameters and excellent survival are obtained with the Less Invasive Ventricular Enhancement technique. In patients with no significant MR and/or myocardial ischemia, ventricular reduction and reshaping, when performed off-pump using the Revivent myocardial anchors, demonstrates long term decrease in heart failure symptoms. CATEGORIES STRUCTURAL: Heart Failure TCT-141 Changes in Left Ventricular Ejection Fraction after Transcatheter Aortic Valve Replacement John Broderick,1 Adam Magier,1 Dean Kereiakes,1 Ian Sarembock,1 Joseph Choo,1 Cheryl Bartone,1 Eugene Chung1 1 The Christ Hospital, Cincinnati, Ohio, United States BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the primary method of aortic valve replacement for intermediatea and high surgical risk patients with aortic stenosis (AS). While prior data support a general rise in EF after TAVR, the relationship between baseline EF and change after TAVR are not well characterized. Accordingly, we evaluated the change in EF and mortality for patients undergoing TAVR in a single center registry. METHODS In 192 patients, Simpson’s biplane EF was measured from echocardiograms obtained at baseline, 1 and 12 months. Patients were stratified according to baseline EF: <40, 40-50 and >50 %; changes in EF at 1 and 12 months are shown (figure). RESULTS Compared with baseline, the average overall EF was 4.7% units greater at 1 mo and 2.5% units at 12 mo. The EF <40 group had a significant increase in EF at each follow up, while the >50 group had a reduction. The 40-50 % EF group did not change in follow up. Further, patients whose EF increased > 10% between BL and 1 mo (average baseline EF ¼ 41%), had a trend toward lower 1-year mortality compared to all other patients (average baseline EF ¼ 55%) (6% vs 15% respectively, p¼0.12).
BACKGROUND To determine if previous admission due to heart failure (HF) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) has a prognostic value in terms of mortality or rehospitalization due to heart failure (rHF) during the first year after TAVI. METHODS Retrospective study involving 349 patients undergoing TAVI. HF was defined according to the ESC guidelines. Pro B-type natriuretic peptide (pro-BNP) was determined in all patients 24 hours before TAVI and 3 months after implantation. Pro-BNP levels were transformed to logarithm to homogenize the sample (log pro-BNP). We analyzed the association between HF and clinical events after TAVI using multivariable logistic regression models. RESULTS The mean age of the population was 82.4 5.7 years, 56% women, with a mean logistic EuroScore of 18.39 10.9% and STS score of 5.9 3.8%.The mean pro-BNP before TAVI was 5051 14661 pg/mL (mean log pro-BNP 3.3 0.51) and at 3 months, 2648 8809 pg/mL (mean log pro-BNP at 3 months 3.02 0.52). 56.7% (n¼198) of the patients had previous admission for HF and 10% (n¼35) of patients had rHF during the first year after TAVI. There was no significant association between the previous HF and rHF during the first year with mortality at follow-up (709 492 days). The results of the multivariate analysis showed that previous HF admission [HR ¼ 4.1; 95% CI, 1.3-13.0; P ¼ 0.016] and high levels of log pro-BNP 3 months after implantation, [HR ¼ 4.4; 95% CI, 1.2-15.4; P ¼ 0.019], were associated with rHF in the first year after TAVI (after adjustment by age, logistic EuroScore, LVEF and log pro-BNP before implantation). CONCLUSION TAVI reduces dramatically the number of heart failure admissions. History HF, previous to TAVI, and rHF, during the first year after TAVI, are not associated with higher mortality rate in the followup. Log pro-BNP at three months after TAVI and previous HF admission are independent predictors of rHF during the first year after TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic HIGH RISK PATIENTS AND TAVR - I
Abstract nos: 143 - 147 TCT-143 Impact of Frailty Markers For Unplanned Hospital Readmission Following Transcatheter Aortic Valve Implantation Mike Saji,1 Ryosuke Higuchi,1 Kenichi Hagiya,2 Itaru Takamisawa,1 Tetsuya Tobaru,1 Nobuo Iguchi,1 Shuichiro Takanashi,2 Morimasa Takayama,2 Mitsuaki Isobe1 1 Sakakibara Heart Institute, Tokyo, Japan; 2Sakakibara Heart Institute, Fuchu, Japan BACKGROUND Frailty has become a major theme in cardiovascular diseases due to the aging population. Recently, variable frailty markers have been developed to guide better patient selection in transcatheter aortic valve implantation (TAVI). This study aimed to investigate the timing, and specific causes of unplanned hospital readmission after initial hospitalization with TAVI, and to investigate which frailty markers could better predict unplanned readmission.
CONCLUSION In a large consecutive patient cohort undergoing TAVR, baseline EF is inversely correlated with change in EF at early and late follow-up. Further, short-term rise in EF may be associated with lower mortality despite higher baseline risk profile (lower baseline EF). The relationship between baseline EF, rapid change in afterload, and subsequent structural and functional responses warrant further study. CATEGORIES STRUCTURAL: Heart Failure
METHODS We retrospectively reviewed 155 patients who underwent TAVI. Although unplanned readmission <30days was 1.9%, quarter of patients had unplanned readmission following TAVI within a year mainly due to heart failure and pneumonia. Short physical-performance battery (SPPB), Placement of AoRTic TraNscathetER Valve (PARTNER) frailty scale, frailty index, clinical frailty scale, modified Fried scale, and gait speed were calculated. The primary endpoints was unplanned hospital readmission following TAVI. Each frailty marker was entered into a multivariate model in addition to variables with p-values <0.25 in a univariate analysis.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
RESULTS With 479 319 days, 64 (41%) patients had unplanned readmission following TAVI. Only three patients (1.9%) required unplanned readmission less than 30 days. Of 64 admissions, 27 were due to cardiac causes, while 37 were noncardiac causes. Of 27 admissions with cardiac reason, 16 (59%) were due to heart failure, while 37 admissions with noncardiac reason, 21 (56%) were due to infection. All frailty markers but the modified Fried scale were found to be independently associated with primary endpoints after adjustment in multivariate analysis. Other independent predictors in multivariate analysis were atrial fibrillation, chronic obstructive pulmonary disease, hemoglobin <11g/dL, estimated gromerular filtration rate (every 15 ml/1.73m2 decrease), and albumin. Furthermore, in receiver operating characteristic analysis, the SPPB had the highest discriminatory performance for predicting primary endpoint (area under the curve 0.71, 95% confidence interval 0.60–0.80, p <0.001). CONCLUSION Precise geriatric assessment is crucial following TAVI as well as index hospitalization in this frail population. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-144 High Pulmonary Vascular Resistance is Associated with Higher Mortality in Transcatheter Aortic Valve Replacement Patients with Pulmonary Hypertension Gavin Hickey,1 Dustin Kliner,2 Jeffrey Xu,3 Floyd Thoma,2 Andrew Althouse,2 Joon Lee,2 John Schindler,2 Thomas Gleason,3 Joao Cavalcante4 1 UPMC, Pittsburgh, Pennsylvania, United States; 2University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; 3 University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States; 4University of Pittsburgh/UPMC, Pittsburgh, Pennsylvania, United States BACKGROUND Pulmonary hypertension (PH) is common in patients with severe aortic stenosis treated with transcatheter aortic valve replacement (TAVR). Though PH in this population is primarily driven by elevated left-sided pressure (post-capillary PH), some patients have increased pulmonary vascular resistance (PVR), thus combined pre- and post-capillary PH. We sought to determine if increased PVR in PH patients undergoing TAVR would be associated with increased mortality when compared to those with normal pulmonary pressure, or elevated pulmonary artery pressure and normal PVR.
B63
CONCLUSION TAVR patients with PH and high PVR have the highest mortality, moreso than those with PH and normal PVR, or without PH. Therefore, PVR provides additional risk stratification in TAVR patients with PH. Use of RHC prior to TAVR may provide useful insight into long-term outcome. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-145 Influence of Cachexia on Mortality after Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Valve Stenosis Lisa Voigtländer,1 Florian Deuschl,1 Niklas Schofer,1 Nicole Rübsamen,1 Moritz Seiffert,1 Daniel Kalbacher,1 Yvonne Schneeberger,1 Johannes Schirmer,1 Hermann Reichenspurner,1 Stefan Blankenberg,1 Lenard Conradi,1 Ulrich Schäfer1 1 University Heart Center Hamburg, Hamburg, Germany BACKGROUND Cachexia is a serious complication of chronic illness, which is associated with a poor prognosis. The patient population undergoing transcatheter aortic valve implantation (TAVI) is, according to the risk selection criteria, in a higher age and with a higher prevalence of comorbidities and chronic illness.The objectives of the study were (i) to determine the prevalence of cachexia and (ii) to examine the prognostic impact of body wasting on short- and longterm-mortality after TAVI. The objectives of the study were (i) to determine the prevalence of cachexia and (ii) to examine the prognostic impact of body wasting on short- and longterm-mortality after TAVI. METHODS Between 2008 and 2014 1045 patients (mean age 80,28.9; mean LogES 20.712.3) with body mass index (BMI)<30 kg/m2 were treated by TAVI in our institution. Patients with BMI>30 kg/m2 were excluded of the study (n¼206).78 (7.5%) of these patients had a BMI<20 kg/m2 and 23 (2.2%) had a BMI<18 kg/m2. BMI<20 kg/m2 was defined as moderate cachexia and BMI<18 kg/m2 as severe cachexia. RESULTS Overall 30-day mortality was 9.2% and 12-month mortality was 26.8%. Patients with cachexia had an increased mortality at 30 days (moderate cachexia: 19.2%; severe cachexia: 38.5%; p1¼0.012; p2<0.001) and at 12 month (moderate cachexia: 30.4%; severe cachexia: 60.9%; p1¼0.009; p2<0.001) (Figure 1). Furthermore, ROC-analysis showed, that BMI<23.7 is associated with an increased mortality.
METHODS We performed a retrospective study of 439 patients treated at a single center who had right heart catheterization (RHC) prior to TAVR. PH was defined as a mean pulmonary artery pressure (mPAP) 25 mmHg. We report the frequency of PH as well as the proportion with PVR 3 Wood units (WU). Kaplan-Meier analysis and Cox proportional-hazards regression were used to quantify the effect of high PVR on subsequent mortality within the PH population. RESULTS Of the 439 patients with baseline RHC, 305 (70%) had PH prior to TAVR, of which 122 (40%) had PVR 3 WU. After adjustment for baseline characteristics using STS-PROM score, TAVR patients with PH and PVR3 had the highest mortality (HR¼1.58, 95% CI 0.95-2.64, p¼0.079), while patients with PH and PVR<3 had only slightly increased mortality (HR¼1.04, 95% CI 0.62-1.75, p¼0.865).
CONCLUSION Cachexia in patients undergoing TAVI is associated with an increased mortality. Especially patients with BMI<18 demonstrated an excess mortality after 30 days and 12 month. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-146 The impact of clinical frailty on one-year mortality post transcatheter aortic valve replacement M. Chadi Alraies,1 Homam Moussa Pacha,2 Elizabeth Bond,1 Kyle Buchanan,3 Toby Rogers,1 Edward Koifman,1 Arie Steinvil,4 Petros Okubagzi,1 Linzhi Xu,1 Rebecca Torguson,3 Itsik Ben-Dor,5 Augusto Pichard,3 Lowell Satler,3 Ron Waksman5