Patterns of Postdischarge Heart Failure, Ischemic, and Bleeding Events After Transcatheter Aortic Valve Replacement

BACKGROUND: Although outcomes after transcatheter aortic valve replacement (TAVR) have improved, heart failure (HF) hospitalization, ischemic events, and major bleeding remain clinical challenges in patients with severe aortic stenosis. OBJECTIVES: The objective of the study was to evaluate the incidence, timing, and prognostic impact of these events after TAVR. METHODS: This two-center retrospective registry included 988 patients with severe aortic stenosis who underwent TAVR. Patients were grouped according to the first clinical event after discharge: HF hospitalization, ischemic events (myocardial infarction or ischemic stroke), major bleeding, or the event-free group. The timing of the first postdischarge event and all-cause mortality after the first event were evaluated. RESULTS: During a median follow-up of 665 days after discharge, 165 patients (16.7%) experienced any of these events. As first events, HF hospitalization, ischemic events, and major bleeding occurred in 80 (8.1%), 32 (3.2%), and 53 (5.4%) patients, respectively, whereas 823 (83.3%) were in the event-free group. Among patients with a first postdischarge event, major bleeding occurred earliest among the 3 event groups. One-year all-cause mortality after the first event was high across groups (HF hospitalization, 31.5%; ischemic events, 30.4%; major bleeding, 25.4%). CONCLUSIONS: Among patients who experienced a first postdischarge event after TAVR, major bleeding occurred earlier than HF hospitalization or ischemic events. Once a first postdischarge event occurred, subsequent all-cause mortality was high across the 3 event groups. These findings suggest that event timing should be considered and careful clinical reassessment may be warranted when a first postdischarge event occurs after TAVR.