Association between delayed transcatheter aortic valve replacement beyond 6 months and clinical outcomes in severe aortic stenosis: a retrospective observational study.
TAVR performed more than 6 months after severe AS diagnosis was independently associated with a higher risk of HF hospitalisation or all-cause mortality (HR 3.47, 95% CI 1.61 to 7.47), with the excess risk predominantly attributable to non-cardiac mortality.
Key Findings
Results
Delayed TAVR (>6 months after severe AS diagnosis) was associated with significantly higher rates of the primary endpoint compared to early TAVR (≤6 months).
Primary endpoint was heart failure (HF) hospitalisation or all-cause mortality.
Primary endpoint occurred in 33% of the delayed group vs 16% of the early group (p=0.0134).
Study included 149 patients: early group n=100, delayed group n=49.
Median follow-up was 729 days.
Patients underwent TAVR between January 2021 and December 2023.
Results
In multivariable Cox regression, delayed TAVR was independently associated with the primary composite endpoint.
Hazard ratio for delayed intervention: HR 3.47, 95% CI 1.61 to 7.47; p=0.0014.
Analysis was adjusted for potential confounders in a multivariable model.
Baseline characteristics were reported to be similar between the two groups.
Results
Higher Clinical Frailty Scale scores were independently associated with the primary endpoint of HF hospitalisation or all-cause mortality.
HR for Clinical Frailty Scale score: 1.62, 95% CI 1.07 to 2.42; p=0.0195.
This association was identified in the same multivariable Cox regression model as delayed intervention.
Frailty was identified as a co-independent predictor alongside timing of intervention.
Results
The excess risk of the primary endpoint in the delayed TAVR group was largely attributable to non-cardiac mortality rather than cardiac causes.
The paper states the excess risk was 'largely attributable to non-cardiac mortality.'
This finding suggests that delayed intervention may allow time for non-cardiac comorbidities to progress and contribute to death.
This pattern was observed during a median follow-up of 729 days.
Background
Current guidelines recommend surveillance intervals of 6–12 months for severe aortic stenosis, but the clinical implications of waiting beyond 6 months had not been clearly established prior to this study.
The study was motivated by uncertainty about outcomes for patients undergoing extended observation due to mild symptoms or comorbidities.
Early intervention for asymptomatic severe AS has been shown to have prognostic benefits.
The authors note that some patients undergo TAVR after extended observation 'owing to mild symptoms or comorbidities.'
Conclusions
The authors concluded that findings emphasise the need for careful clinical surveillance and may support more frequent reassessment in selected high-risk patients.
The study design was retrospective and observational.
The study was conducted at a single centre over a 3-year period (January 2021 to December 2023).
Authors suggest the results 'may support more frequent reassessment in selected high-risk patients.'
What This Means
This research suggests that patients with severe aortic stenosis (a narrowing of the heart's aortic valve) who waited more than 6 months before receiving a transcatheter aortic valve replacement (TAVR, a minimally invasive valve replacement procedure) had significantly worse outcomes than those treated within 6 months. Among 149 patients studied over a median follow-up of about two years, one-third of those in the delayed treatment group were hospitalised for heart failure or died, compared to about one in six in the early treatment group. After accounting for other factors, delayed treatment was associated with more than three times the risk of these adverse outcomes.
Notably, the increased risk in the delayed group was driven more by non-cardiac deaths than by heart-related deaths. This suggests that waiting longer for valve replacement may allow other health conditions to worsen in the meantime, ultimately contributing to death from causes unrelated to the heart. The study also found that higher frailty scores (a measure of overall physical vulnerability) were independently linked to worse outcomes, highlighting that the general health status of patients matters alongside the timing of intervention.
This research suggests that waiting beyond 6 months after a diagnosis of severe aortic stenosis may carry meaningful clinical risks, even when patients appear relatively stable. The findings point to a potential need for closer and more frequent monitoring of patients who are being observed rather than treated promptly, particularly those who are frailer or have more comorbidities. Because this was a retrospective, single-centre study, larger prospective studies would be needed to confirm these findings and refine guidance on optimal timing of intervention.
Omuro A, Okuda S, Miyazaki Y, Tamitani M, Nawata J, Nakashima Y, et al.. (2026). Association between delayed transcatheter aortic valve replacement beyond 6 months and clinical outcomes in severe aortic stenosis: a retrospective observational study.. Open heart. https://doi.org/10.1136/openhrt-2026-004403