64 Predictors of 30-day mortality following transcatheter aortic valve implantation: insights from a single-centre registry

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Introduction Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis with favourable outcomes across a broad range of risk profiles. However, a low but persistent risk of early mortality remains. Identification of clinical and procedural factors associated with 30-day mortality may improve risk stratification and guide patient management. Methods We conducted a retrospective observational study of consecutive patients who underwent TAVI at a single tertiary referral centre between 01/01/2019 to 31/12/2024. The primary endpoint was all-cause mortality within 30 days post-procedure. Baseline demographics, comorbidities, echocardiographic parameters, laboratory values, and procedural details were obtained from the St. James’s Hospital TAVI registry. Univariate analysis was performed using chi-square tests for categorical variables and independent samples t-tests for continuous variables. A p-value <0.05 was considered statistically significant. Results Among patients (n=592), 2.7% (n=16) died within 30 days. Mortality was associated with lower left ventricular ejection fraction (37.9% vs. 48.7%, p <0.001), serum albumin (35.3 vs. 39.8 g/L, p<0.001), and higher NT-proBNP (13,478 vs. 4,518 pg/mL, p=0.004) and EuroSCORE II (12.7 vs. 5.0, p<0.001). Additionally, NYHA class III/IV (p=0.045), prior myocardial infarction (p<0.001), dialysis dependence (p<0.001), the use of transaortic or transapical access (p<0.001) and significant coronary artery disease (p=0.008) were linked to higher mortality (tables 1 & 2). Conclusion Among our cohort, thirty-day mortality post TAVI occurred at a similarly low rate to that seen in the literature and was strongly influenced by baseline cardiac function, markers of frailty, and procedural factors. High-risk features included reduced LVEF, elevated NT-proBNP, high EuroSCORE II, and advanced NYHA class. These findings may assist in pre-procedural risk assessment. Due to the small number of events, multivariate analysis was not pursued to avoid model overfitting. Further multicentre studies with larger event rates are needed to validate and expand upon these observations.

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