Optimizing patient triage on the waiting list for transcatheter aortic valve replacement: The clinical utility of the cardiac damage staging system - 08/01/26
, A. Carmona 2, F. Severac 3, A. Trimaille 2, K. Roulot 4, M. Kibler 2, P. Ohlmann 5, B. Marchandot 6, S. Kikuchi 7, O. Morel 3Résumé |
Introduction |
Importance Access to TAVR is generally prioritized for symptomatic patients presenting with severe heart failure, syncope, angina and echocardiographic parameters as left ventricular ejection fraction (LVEF). However, a substantial number of patients die while awaiting TAVR.
Objective |
In response to rising demand driven by an aging population, it is essential to stratify interventions, as proposed by Généreux's Aortic Stenosis staging.
Method |
We conducted a retrospective, single-center, longitudinal study in patients referred for TAVR. We specifically analyzed the characteristics of 98 patients who died while on the TAVR waiting list ( Fig. 1 ). The cumulative incidence of death on the waiting list was estimated using a competing-risk approach. The primary outcome were death or removal from the TAVR waiting list.
Results |
The overall proportion of deceased patients was 8.4% (95% CI, 6.9–10.1). By 3 months, 61.2% of patients had undergone TAVR, and this increased to 85.4% at 6 months. Deaths occurred in 6.3% of patients by 3 months and 7.8% by 6 months. We notice that 90% of deaths took place within the first three months ( Fig. 2 ). Multivariable analysis identified several variables independently associated with mortality on the TAVR waiting list: elevated C-reactive protein (CRP) remained significant (sHR, 2.72 [95% CI, 1.64–4.51]; P < 0.001), dyslipidemia (sHR, 1.75 [95% CI, 1.03–2.97]; P = 0.039), prior myocardial infarction (sHR, 1.87 [95% CI, 1.12–3.13]; P = 0.017), and pulmonary artery systolic pressure > 60 mmHg (sHR, 2.37 [95% CI, 1.36–4.12]; P = 0.002). In contrast, an LVEF < 40% was protective (sHR, 0.44 [95% CI, 0.23–0.87]; P = 0.018), as was NYHA class III–IV dyspnea (sHR, 0.48 [95% CI, 0.24–0.97]; P = 0.041). Généreux stages 3 and 4 showed a strong association with waiting-list mortality, more than doubling the risk of death (sHR, 2.12 [95% CI, 1.33–2.12]; P = 0.002).
Conclusion |
These findings suggest that TAVR candidates at Généreux stages 3 and 4 should receive higher priority on the waiting list. Moreover, right ventricular fractional shortening impairment and elevated pulmonary artery systolic pressure were both linked to higher mortality rates among patients awaiting TAVR.
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Vol 119 - N° 1S
P. S80 - janvier 2026 Retour au numéro
Article précédent
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