title: Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death.
abstract: BACKGROUND
  Little evidence exists of the burden and predictors of cardiac death after transcatheter aortic valve replacement (TAVR).
  
  
  OBJECTIVE
  The purpose of this study was to assess the incidence and predictors of cardiac death from advanced heart failure (HF) and sudden cardiac death (SCD) in a large patient cohort undergoing TAVR.
  
  
  METHODS
  The study included a total of 3,726 patients who underwent TAVR using balloon (57%) or self-expandable (43%) valves. Causes of death were defined according to the Valve Academic Research Consortium-2.
  
  
  RESULTS
  At a mean follow-up of 22 ± 18 months, 155 patients had died due to advanced HF (15.2% of total deaths, 46.1% of deaths from cardiac causes) and 57 had died due to SCD (5.6% of deaths, 16.9% of cardiac deaths). Baseline comorbidities (chronic obstructive pulmonary disease, atrial fibrillation, left ventricular ejection fraction ≤40%, lower mean transaortic gradient, pulmonary artery systolic pressure >60 mm Hg; p < 0.05 for all) and 2 procedural factors (transapical approach, hazard ratio [HR]: 2.38, 95% confidence interval [CI]: 1.60 to 3.54; p < 0.001; presence of moderate or severe aortic regurgitation after TAVR, HR: 2.79, 95% CI: 1.82 to 4.27; p < 0.001) independently predicted death from advanced HF. Left ventricular ejection fraction ≤40% (HR: 1.93, 95% CI: 1.05 to 3.55; p = 0.033) and new-onset persistent left bundle-branch block following TAVR (HR: 2.26, 95% CI: 1.23 to 4.14; p = 0.009) were independently associated with an increased risk of SCD. Patients with new-onset persistent left bundle-branch block and a QRS duration >160 ms had a greater SCD risk (HR: 4.78, 95% CI: 1.56 to 14.63; p = 0.006).
  
  
  CONCLUSIONS
  Advanced HF and SCD accounted for two-thirds of cardiac deaths in patients after TAVR. Potentially modifiable or treatable factors leading to increased risk of mortality for HF and SCD were identified. Future studies should determine whether targeting these factors decreases the risk of cardiac death.
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Marina
authors: M
authors: Urena
authors: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors: John G
authors: JG
authors: Webb
authors: Hôpital Charles Nicolle, University of Rouen, Rouen, France.
authors: Helene
authors: H
authors: Eltchaninoff
authors: Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
authors: Antonio J
authors: AJ
authors: Muñoz-García
authors: Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Claire
authors: C
authors: Bouleti
authors: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Corrado
authors: C
authors: Tamburino
authors: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors: Luis
authors: L
authors: Nombela-Franco
authors: University Heart Center, Transcatheter Valve Clinic, University Hospital Zurich, Zurich, Switzerland.
authors: Fabian
authors: F
authors: Nietlispach
authors: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Cesar
authors: C
authors: Moris
authors: Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors: Marc
authors: M
authors: Ruel
authors: Clìnica de Occidente de Cali, Valle del Cauca, Colombia.
authors: Antonio E
authors: AE
authors: Dager
authors: Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Vicenç
authors: V
authors: Serra
authors: St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors: Asim N
authors: AN
authors: Cheema
authors: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors: Ignacio J
authors: IJ
authors: Amat-Santos
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Fabio Sandoli
authors: FS
authors: de Brito
authors: Heart Institute-InCor, University of São Paulo, São Paulo, Brazil.
authors: Pedro Alves
authors: PA
authors: Lemos
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors: Alexandre
authors: A
authors: Abizaid
authors: Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Rogério
authors: R
authors: Sarmento-Leite
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Henrique B
authors: HB
authors: Ribeiro
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: Eric
authors: E
authors: Dumont
authors: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Marco
authors: M
authors: Barbanti
authors: Hôpital Charles Nicolle, University of Rouen, Rouen, France.
authors: Eric
authors: E
authors: Durand
authors: Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
authors: Juan H
authors: JH
authors: Alonso Briales
authors: Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Dominique
authors: D
authors: Himbert
authors: Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Alec
authors: A
authors: Vahanian
authors: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors: Sebastien
authors: S
authors: Immè
authors: Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors: Eulogio
authors: E
authors: Garcia
authors: University Heart Center, Transcatheter Valve Clinic, University Hospital Zurich, Zurich, Switzerland.
authors: Francesco
authors: F
authors: Maisano
authors: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Raquel
authors: R
authors: del Valle
authors: Clìnica de Occidente de Cali, Valle del Cauca, Colombia.
authors: Luis Miguel
authors: LM
authors: Benitez
authors: Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors: Bruno
authors: B
authors: García del Blanco
authors: Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors: Hipólito
authors: H
authors: Gutiérrez
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors: Marco Antonio
authors: MA
authors: Perin
authors: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors: Dimytri
authors: D
authors: Siqueira
authors: Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Guilherme
authors: G
authors: Bernardi
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors: François
authors: F
authors: Philippon
authors: Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors: Josep
authors: J
authors: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D011237:Predictive Value of Tests; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome
keywords: aortic stenosis; heart failure; sudden cardiac death; transcatheter aortic valve implantation; transcatheter aortic valve replacement