Acute Heart Failure At The Time Of TAVR Does Not Increase Mortality
William Burke, Jaimin R. Trivedi, Michael P. Flaherty, Kendra J. Grubb.
University of Louisville, Louisville, KY, USA.
OBJECTIVE: Patients presenting for transcatheter aortic valve replacement (TAVR) are often in acute on chronic heart failure, as indicated by an elevated proBNP. Many believe an elevated proBNP is an indication to treat medically, reserving surgery until the patient is medically optimized.
METHODS: A single center transcatheter heart valve therapy database was queried from December 2015 to November 2016 to identify patients undergoing TAVR. Patients were divided into two cohorts based on preoperative proBNP. Patients in cohort 1 had proBNP ≤ 3000 and patients in cohort 2 had proBNP >3000. A analysis was then completed to assess outcomes such as length of ICU stay, total length of stay, discharge to home, and mortality at 30 days.
RESULTS: There were 142 patients (median age: 80 years, 44% female) with preoperative proBNP data included in the final dataset (range 106 to 73,500). The mean STS risk was 8%, albumin was 3.5 ± 0.6 mg%. There were 46 patients (32%) with proBNP >3000. ProBP >3000 was associated only with increased ICU length of stay (35% vs 9%, p=0.0001). There was no statistical difference between cohorts in regard to total length of stay (24% vs 15%, p=0.2), discharge to home (74% vs 83%, p=0.3), and mortality at 30 days (2.1% vs 2.1%, p=0.6).
CONCLUSIONS: TAVR is an effective treatment for patients presenting with acute on chronic heart failure. Specifically, TAVR is appropriate and effective for patients with high levels of proBNP and is associated with statistically similar length of stay and mortality rates at 30 days.
Figure 1. Assessment of outcomes based on preoperative proBNP level. No difference in mortality at 30 days but a statistically significant increase in hours in the ICU for patients presenting with proBNP >3000.
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