Death on waiting list for transcatheter aortic valve implantation: Current incidence, clinical characteristics and predictive factors.

Abstract

Background: The rapid and exponential growth in demand for transcatheter aortic valve implantation (TAVI) tends to overwhelm current capacity, leading to prolonged waiting times for TAVI.

Aims: To investigate current waiting times for TAVI, the incidence of death on waiting list for TAVI, clinical characteristics and factors predictive of death before TAVI.

Methods: A total of 1495 patients referred for TAVI in two French centres (TAVI centre, n=790; and non-TAVI centre, n=705) were included for analysis.

Results: The mean age of the population was 82years. The median waiting time was 79 (interquartile range: 49-119) days, and was longer in the non-TAVI centre than in the TAVI centre (105 vs. 64days; P<0.001). The overall rate of death on waiting list was 5.8% (n=86), with the majority of deaths related to cardiovascular causes. Most patients (63%) died within the first 2months on the waiting list, with a linear occurrence of death without clear threshold. Impaired renal function (odds ratio: 2.12, 95% confidence interval: 1.30-3.45; P=0.003) and left ventricular ejection fraction<50% (odds ratio: 2.90, 95% confidence interval: 1.83-4.62; P<0.001) were identified as independent predictors of death on waiting list.

Conclusions: The delay between patient referral and TAVI procedure is longer than 2.5months in half of cases, with a steady increase over the years and longer delays in centres without on-site TAVI facilities. One in 20 patients dies while on the waiting list for TAVI, with two thirds of deaths occurring within the first 2months on the waiting list. Impaired renal function and left ventricular ejection fraction<50% determine an increased risk of death.