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Delayed access to TAVR found detrimental for high-risk, inoperable patients
Increasing the wait time before performing transcatheter aortic valve replacement increased mortality rates in inoperable and high-risk patients with aortic stenosis, concluded recent findings.
Patients who are either inoperable or are at high risk for surgery increasingly require TAVR as the primary treatment option, researchers suggested. They undertook a mathematical simulation using data from the PARTNER trials to estimate whether TAVR would be effective as wait times increase. Several comparisons were made, including TAVR with medical therapy among inoperable patients, and TAVR with conventional aortic valve surgery among high-risk candidates.
The researchers calculated 1-year mortality and deaths in the waiting period. These endpoints were estimated for different scenarios and wait times ranging from 10 days to 180 days, while the surgery wait time was maintained at 15.6 days.
The 1-year mortality rate associated with medical therapy in the inoperable cohort was 50%. For a 10-day TAVR wait time, a 1.9% TAVR wait-time mortality rate was reported, along with a 1-year mortality rate of 31.5%. A 180-day wait time increased TAVR wait-time mortality by 28.9%. The 180-day wait time yielded a 1-year mortality rate of 41.4%.
For high-risk patients, the wait-time mortality rate for surgical patients was 2.5%. One-year mortality was 27% in this cohort.
Also in the high-risk group, a 2.2% increase in TAVR wait-time mortality occurred with a 10-day wait time. For 180 days waiting, a 22.4% increase in mortality was reported. This increase was associated with a corresponding increase in 1-year mortality from 24.5% to 32.6%.
As the wait time increased beyond 60 days, the mortality rate for TAVR exceeded the rate for surgery.
“Modest increases in TAVR wait-times have substantial impact on the effectiveness of TAVR in both inoperable patients and high-risk surgical candidates,” the researchers concluded.
Disclosure: The researchers report financial disclosures with Edwards Lifesciences and Medtronic.