Background: Patients with severe aortic stenosis and heart failure have
poor prognosis, and their outcomes may be suboptimal even after
transcatheter (TAVR) and surgical aortic valve replacement (SAVR).
Methods: This is an analysis of the nationwide FinnValve registry, which
included patients who underwent primary TAVR or SAVR with a
bioprothesis for aortic stenosis. We evaluated the outcome of patients
with acute heart failure (AHF) within 60 days prior to TAVR or SAVR.
Results: The prevalence of recent AHF was 11.4% (484 of 4241 patients)
in the SAVR cohort and 11.3% (210 of 1855 patients) in the TAVR cohort.
In the SAVR cohort, AHF was associated with lower 30-day survival (91.3%
vs 97.0%; adjusted odds ratio 1.801, 95% confidence interval [CI]
1.125-2.882) and 5-year survival (64.0% vs 81.2%; adjusted hazard ratio
1.482, 95% CI 1.207-1.821). SAVR patients with AHF had higher risk of
major bleeding, need of mechanical circulatory support, acute kidney
injury, prolonged hospital stay, and composite end-point (30-day
mortality, stroke and/or acute kidney injury). Patients with AHF had a
trend toward lower 30-day survival (crude rates 95.2% vs 97.9%; adjusted
odds ratio 2.028, 95% CI 0.908-4.529) as well as significantly lower
5-year survival (crude rates 45.3% vs 58.5%; adjusted hazard ratio
1.530, 95% CI 1.185-1.976) also after TAVR. AHF increased the risk of
acute kidney injury, prolonged hospital stay, and composite end-point
after TAVR. Conclusions: Recent AHF is associated with increased risk of
mortality and morbidity after SAVR and TAVR. These findings suggest
that aortic stenosis patients should be referred for invasive treatment
before the development of clinically evident heart failure.