Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong?

Overview

Journal J Cardiovasc Dev Dis

Specialty Cardiology & Vascular Diseases

Date 2023 Jun 27

PMID 37367409

Authors

Fortunato Iacovelli

Francesco Loizzi

Alessandro Cafaro

Osvaldo Burattini

Luigi Salemme

Angelo Cioppa

Francesco Rizzo

Chiara Palmitessa

Maurizio DAlessandro

Daniele De Feo

Armando Pucciarelli

Emanuela De Cillis

Vincenzo Pestrichella

Gaetano Contegiacomo

Tullio Tesorio

Alessandro Santo Bortone

Affiliations

Soon will be listed here.

Abstract

Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis.

Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents.

Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality.

Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.

Citing Articles

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Jalali Y, Jalali M, Stevlik J J Clin Med. 2024; 13(11).

PMID: 38892948 PMC: 11173198. DOI: 10.3390/jcm13113240.

Fluoroscopy Time as a New Predictor of Short-Term Outcomes after Transcatheter Aortic Valve Replacement.

Cafaro A, Spione F, Burattini O, De Feo D, Xhelo A, Palmitessa C J Cardiovasc Dev Dis. 2023; 10(11).

PMID: 37998517 PMC: 10671838. DOI: 10.3390/jcdd10110459.

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