Hafid Amrane1, G Michael Deeb2, Jeffrey J Popma3, Steven J Yakubov4, Thomas G Gleason5, Nicolas M Van Mieghem6, Michael J Reardon7. 1. Department of Cardiac and Thoracic Surgery, Medisch Centrum Leeuwarden, The Netherlands. 2. Department of Cardiac Surgery, University of Michigan Hospitals, Ann Arbor, Mich. 3. Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. 4. Department of Interventional Cardiology; Riverside Methodist-Ohio Health, Columbus, Ohio. 5. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. 6. Department of Interventional Cardiology, Eramus Medical Center, Rotterdam, The Netherlands. 7. Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex. Electronic address: mreardon@houstonmethodist.org.
Abstract
OBJECTIVES: Examine the causes and timing of death in the Surgical Replacement and Transcatheter Aortic Valve Implantation intermediate-risk randomized trial for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS: Causes of death were adjudicated by an independent clinical event committee and by post-hoc hierarchical classification. Causes of death were evaluated and characteristics and procedural parameters compared between patients who died and survivors for 3 time periods: early (0-30 days), recovery (31-120 days), and late (121-365 days). RESULTS: All-cause mortality at 1 year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in mortality rates between TAVR and SAVR for any of the 3 time periods. Early mortality was primarily due to technical, procedure-related problems in TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths during recovery were caused by complications. Other causes, including comorbid conditions, accounted for most late deaths. CONCLUSIONS:Mortality rates were similar for patients treated with TAVR or SAVR at any time period including at 1 year. Early cause of death was more commonly technical failure after TAVR and due to complications after SAVR. Recovery phase cause of death was dominated by complications from TAVR and SAVR. Late cause of death appeared to be independent of the procedure in both groups.
RCT Entities:
OBJECTIVES: Examine the causes and timing of death in the Surgical Replacement and Transcatheter Aortic Valve Implantation intermediate-risk randomized trial for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS: Causes of death were adjudicated by an independent clinical event committee and by post-hoc hierarchical classification. Causes of death were evaluated and characteristics and procedural parameters compared between patients who died and survivors for 3 time periods: early (0-30 days), recovery (31-120 days), and late (121-365 days). RESULTS: All-cause mortality at 1 year was 6.5% after TAVR and 6.7% after SAVR. There were no differences in mortality rates between TAVR and SAVR for any of the 3 time periods. Early mortality was primarily due to technical, procedure-related problems in TAVR and due to complications in SAVR. For TAVR and SAVR, most deaths during recovery were caused by complications. Other causes, including comorbid conditions, accounted for most late deaths. CONCLUSIONS:Mortality rates were similar for patients treated with TAVR or SAVR at any time period including at 1 year. Early cause of death was more commonly technical failure after TAVR and due to complications after SAVR. Recovery phase cause of death was dominated by complications from TAVR and SAVR. Late cause of death appeared to be independent of the procedure in both groups.
Authors: Stephanie Louise Swift; Thomas Puehler; Kate Misso; Shona Helen Lang; Carol Forbes; Jos Kleijnen; Marion Danner; Christian Kuhn; Assad Haneya; Hatim Seoudy; Jochen Cremer; Norbert Frey; Georg Lutter; Robert Wolff; Fueloep Scheibler; Kai Wehkamp; Derk Frank Journal: BMJ Open Date: 2021-12-06 Impact factor: 2.692