Academic Journal
Optimizing patient triage on the waiting list for transcatheter aortic valve replacement: the clinical utility of the cardiac damage staging system
| Title: | Optimizing patient triage on the waiting list for transcatheter aortic valve replacement: the clinical utility of the cardiac damage staging system |
|---|---|
| Authors: | Boyer, Karen, Carmona, Adrien, Severac, Francois, Trimaille, Antonin, Roulot, Kévin, Kikuchi, Shinnosuke, Kibler, Marion, Ohlmann, Patrick, Marchandot, Benjamin, Morel, Olivier |
| Contributors: | GERCA |
| Source: | European Heart Journal - Quality of Care and Clinical Outcomes ; ISSN 2058-5225 2058-1742 |
| Publisher Information: | Oxford University Press (OUP) |
| Publication Year: | 2026 |
| Description: | Aims Access to transcatheter aortic valve replacement (TAVR) is generally prioritized for symptomatic patients presenting with severe heart failure, syncope, angina, and decrease in left ventricular ejection fraction <40%. However, a substantial number of patients die while awaiting TAVR. In response to rising demand driven by an ageing population, it is essential to stratify interventions, as proposed by Généreux’s Aortic Stenosis staging. Methods and results We conducted a retrospective, single-center, longitudinal study in patients referred for TAVR. We specifically analysed the characteristics of 98 patients who died while on the TAVR waiting list. The primary outcome was all-cause mortality from the time of a patient’s inclusion on the TAVR waiting list or non-proceeding to TAVR. The overall proportion of deceased patients was 8.4% [95% confidence interval (CI), 6.9–10.1] and 4% when excluding deaths occurring after 2019. 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 3 months. Multivariable analysis identified several variables independently associated with mortality on the TAVR waiting list: prior myocardial infarction [subdistribution hazard ratio (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]. 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, 1.33–3.38); P = 0.002]. Conclusion These findings suggest that TAVR candidates at Généreux stages 3 and 4 should receive higher priority on the waiting list. |
| Document Type: | article in journal/newspaper |
| Language: | English |
| DOI: | 10.1093/ehjqcco/qcag001 |
| DOI: | 10.1093/ehjqcco/qcag001/67209728/qcag001.pdf |
| Availability: | https://doi.org/10.1093/ehjqcco/qcag001 https://academic.oup.com/ehjqcco/advance-article-pdf/doi/10.1093/ehjqcco/qcag001/67209728/qcag001.pdf |
| Rights: | https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: | edsbas.8DA4507B |
| Database: | BASE |
| FullText | Text: Availability: 0 CustomLinks: – Url: https://doi.org/10.1093/ehjqcco/qcag001# Name: EDS - BASE (ns324271) Category: fullText Text: View record from BASE |
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| Items | – Name: Title Label: Title Group: Ti Data: Optimizing patient triage on the waiting list for transcatheter aortic valve replacement: the clinical utility of the cardiac damage staging system – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Boyer%2C+Karen%22">Boyer, Karen</searchLink><br /><searchLink fieldCode="AR" term="%22Carmona%2C+Adrien%22">Carmona, Adrien</searchLink><br /><searchLink fieldCode="AR" term="%22Severac%2C+Francois%22">Severac, Francois</searchLink><br /><searchLink fieldCode="AR" term="%22Trimaille%2C+Antonin%22">Trimaille, Antonin</searchLink><br /><searchLink fieldCode="AR" term="%22Roulot%2C+Kévin%22">Roulot, Kévin</searchLink><br /><searchLink fieldCode="AR" term="%22Kikuchi%2C+Shinnosuke%22">Kikuchi, Shinnosuke</searchLink><br /><searchLink fieldCode="AR" term="%22Kibler%2C+Marion%22">Kibler, Marion</searchLink><br /><searchLink fieldCode="AR" term="%22Ohlmann%2C+Patrick%22">Ohlmann, Patrick</searchLink><br /><searchLink fieldCode="AR" term="%22Marchandot%2C+Benjamin%22">Marchandot, Benjamin</searchLink><br /><searchLink fieldCode="AR" term="%22Morel%2C+Olivier%22">Morel, Olivier</searchLink> – Name: Author Label: Contributors Group: Au Data: GERCA – Name: TitleSource Label: Source Group: Src Data: European Heart Journal - Quality of Care and Clinical Outcomes ; ISSN 2058-5225 2058-1742 – Name: Publisher Label: Publisher Information Group: PubInfo Data: Oxford University Press (OUP) – Name: DatePubCY Label: Publication Year Group: Date Data: 2026 – Name: Abstract Label: Description Group: Ab Data: Aims Access to transcatheter aortic valve replacement (TAVR) is generally prioritized for symptomatic patients presenting with severe heart failure, syncope, angina, and decrease in left ventricular ejection fraction <40%. However, a substantial number of patients die while awaiting TAVR. In response to rising demand driven by an ageing population, it is essential to stratify interventions, as proposed by Généreux’s Aortic Stenosis staging. Methods and results We conducted a retrospective, single-center, longitudinal study in patients referred for TAVR. We specifically analysed the characteristics of 98 patients who died while on the TAVR waiting list. The primary outcome was all-cause mortality from the time of a patient’s inclusion on the TAVR waiting list or non-proceeding to TAVR. The overall proportion of deceased patients was 8.4% [95% confidence interval (CI), 6.9–10.1] and 4% when excluding deaths occurring after 2019. 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 3 months. Multivariable analysis identified several variables independently associated with mortality on the TAVR waiting list: prior myocardial infarction [subdistribution hazard ratio (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]. 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, 1.33–3.38); P = 0.002]. Conclusion These findings suggest that TAVR candidates at Généreux stages 3 and 4 should receive higher priority on the waiting list. – Name: TypeDocument Label: Document Type Group: TypDoc Data: article in journal/newspaper – Name: Language Label: Language Group: Lang Data: English – Name: DOI Label: DOI Group: ID Data: 10.1093/ehjqcco/qcag001 – Name: DOI Label: DOI Group: ID Data: 10.1093/ehjqcco/qcag001/67209728/qcag001.pdf – Name: URL Label: Availability Group: URL Data: https://doi.org/10.1093/ehjqcco/qcag001<br />https://academic.oup.com/ehjqcco/advance-article-pdf/doi/10.1093/ehjqcco/qcag001/67209728/qcag001.pdf – Name: Copyright Label: Rights Group: Cpyrght Data: https://creativecommons.org/licenses/by/4.0/ – Name: AN Label: Accession Number Group: ID Data: edsbas.8DA4507B |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1093/ehjqcco/qcag001 Languages: – Text: English Titles: – TitleFull: Optimizing patient triage on the waiting list for transcatheter aortic valve replacement: the clinical utility of the cardiac damage staging system Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Boyer, Karen – PersonEntity: Name: NameFull: Carmona, Adrien – PersonEntity: Name: NameFull: Severac, Francois – PersonEntity: Name: NameFull: Trimaille, Antonin – PersonEntity: Name: NameFull: Roulot, Kévin – PersonEntity: Name: NameFull: Kikuchi, Shinnosuke – PersonEntity: Name: NameFull: Kibler, Marion – PersonEntity: Name: NameFull: Ohlmann, Patrick – PersonEntity: Name: NameFull: Marchandot, Benjamin – PersonEntity: Name: NameFull: Morel, Olivier – PersonEntity: Name: NameFull: GERCA IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2026 Identifiers: – Type: issn-locals Value: edsbas – Type: issn-locals Value: edsbas.oa Titles: – TitleFull: European Heart Journal - Quality of Care and Clinical Outcomes ; ISSN 2058-5225 2058-1742 Type: main |
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