Chayakrit Krittanawong, MD Section of Cardiology Baylor College of Medicine Houston, TX

Predictors of In-Hospital Mortality after TAVI Interview with:

Chayakrit Krittanawong, MD Section of Cardiology Baylor College of Medicine Houston, TX

Dr. Krittanawong

Chayakrit Krittanawong, MD
Section of Cardiology
Baylor College of Medicine
Houston, TX What is the background for this study?

Response: Transcatheter Aortic valve Implantation (TAVI) has emerged as equally effective alternative to surgical aortic valve replacement (SAVR) to treat severe aortic stenosis (AS) in all risk groups. In particular, less is known about the heart failure (HF) patients who undergo TAVI. Whether certain subtypes of HF respond differently after TAVI remains a mystery.

In this study, we sought to assess and compare the incidence and predictors of in-hospital mortality among patients with heart failure with preserved ejection fraction (HFREF) versus heart failure with preserved ejection fraction (HFPEF). What are the main findings?

Response: More than half of the patients who undergo TAVI has baseline heart failure. Two thirds these HF patients belong to HFPEF subset. Although the incidence of in-hospital mortality is similar in both subgroups who undergo TAVI, predictors of mortality are different. Valvular heart disease was significant predictor of mortality in HFREF patients whereas elderly patients with liver disease were at higher risk of mortality in HFPEF patient population. What should readers take away from your report?

1. Among TAVI patients, HF patients have similar in-hospital mortality as compared to the patients without HF. Therefore, presence of HF should not be considered a prohibitive risk to undergo TAVI for severe AS.

2. Patients with chronic kidney disease and electrolyte abnormalities should be monitored, treated and followed up closely with multidisciplinary team as these are independent predictors of in-hospital mortality.

3. Majority of heart failure patients who undergo TAVI had preserved EF. This is likely due to similar risk factors profile shared by HFPEF patients and severe aortic stenosis patients. What recommendations do you have for future research as a result of this work?

1. Patients with low ejection fraction are considered to be in burnt-out stage of aortic stenssis and has high mortality. But our study shows similar mortality in these patients after getting TAVI when compared to patients with preserved EF. Does TAVI reverses the myocardial remodeling and improves EF by relieving outflow obstruction needs to be studied at molecular as well as as clinical level.

2. Valvular heart disease in HFREF patients and increasing age, liver disease and absence of anemia and depression in HPEF patients were predictors of higher in-hospital mortality TAVI patients. Further studies are warranted to confirm these findings.

3. Although, HFREF and HFPEF compromise the half of he heart failure patient population each, two thirds of HF patients who underwent TAVI had HFPEF. This discrepancy in the ratio of HPEF patients in general HF population versus TAVI patients needs to be sought out. 

Dr. Chayakrit Krittanawong, MD  has no financial interests to disclose.


Predictors of In-Hospital Mortality after Transcatheter Aortic Valve Implantation
Krittanawong, Chayakrit et al.
American Journal of Cardiology, Volume 0, Issue 0



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Last Updated on November 21, 2019 by Marie Benz MD FAAD