One in 25 TAVI Patients Die Within a Year, Mostly From Noncardiovascular Causes: Study
Italy: A large analysis from the TRITAVI registry has revealed that among patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe aortic stenosis in Europe, approximately 4% (about one in 25) died between 30 days and 12 months after the procedure. Importantly, most deaths were due to noncardiovascular causes rather than heart-related complications.
The strongest predictors of mortality during this period were chronic obstructive pulmonary disease (COPD), atrial fibrillation (AF), severe chronic kidney disease (CKD), and reduced left ventricular ejection fraction. These findings highlight the importance of comprehensive management of comorbid conditions following TAVI to improve long-term outcomes.
The findings were published in the American Heart Journal by Fabrizio D’Ascenzo and colleagues.
TAVI is widely used to treat severe symptomatic aortic stenosis, particularly in older adults and patients at high surgical risk. To better understand mortality after successful procedures, researchers analyzed data from the TRITAVI registry.
The multicenter European registry included patients who underwent TAVI without major peri-procedural complications, such as significant vascular injury, severe acute kidney injury, or blood transfusion. The primary outcome was all-cause mortality between 30 days and 1 year after the procedure.
A total of 11,246 patients were included, with a mean age of 82 years and 52% being women. Despite uncomplicated procedures, 454 patients (4%) died during the first year of follow-up.
The following were the key findings:
- Among 11,246 patients with uncomplicated TAVI, 454 (4%) died between 30 days and 1 year after the procedure.
- Of these, 78 deaths (0.7%) were cardiovascular and 376 deaths (3.3%) were non-cardiovascular.
- Non-cardiovascular causes accounted for 83% of all deaths during follow-up.
- The risk of non-cardiovascular death increased steadily over the first year and was markedly higher than the risk of cardiovascular death.
- Atrial fibrillation, COPD, severe CKD, and reduced LVEF were key predictors of mortality.
- Severe CKD increased the risk of death by 70%.
- Atrial fibrillation was associated with a 46% higher risk of mortality.
- Moderate and severe reductions in LVEF were both linked to worse outcomes.
- Higher baseline creatinine levels were associated with an increased risk of non-cardiovascular death.
- Atrial fibrillation was also linked to a greater likelihood of non-cardiovascular mortality.
- Higher baseline LVEF was associated with a lower risk of death during follow-up.
- Traditional surgical risk scores had limited ability to predict cause-specific mortality after TAVI.
The authors noted several limitations, including the lack of detailed frailty data, limited information on other valvular diseases and heart failure, and the long enrollment period during which TAVI practices evolved. Cause-of-death data were also restricted to cardiovascular and non-cardiovascular categories.
The researchers concluded that mortality within the first year after uncomplicated TAVI remains clinically relevant and is largely driven by non-cardiovascular causes. They highlighted atrial fibrillation, COPD, chronic kidney disease, and reduced ventricular function as key predictors of adverse outcomes, supporting the need for more comprehensive and individualized risk assessment before and after TAVI.
Reference:
D’Ascenzo, F., De Filippo, O., Pelliccia, F., Pasceri, V., Dangas, G., Mehran, R., Porto, I., Radico, F., Biancari, F., Saia, F., Luzi, G., Bedogni, F., Santos, I. J. A., De Marzo, V., Dimagli, A., Mäkikallio, T., Sandrone, S., Stabile, E., Blasco-Turrión, S., . . . Zimarino, M. (2026). Potentially futile outcome after uncomplicated TAVI: Insights from the TRITAVI registry. American Heart Journal, 107488. https://doi.org/10.1016/j.ahj.2026.107488
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