Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score

Iung, Bernard; Laouénan, Cédric; Himbert, Dominique; Eltchaninoff, Hélène; Chevreul, Karine; Donzeau–Gouge, Patrick; Fajadet, Jean; Leprince, Pascal; Leguerrier, Alain; Lièvre, Michel; Prat, Alain; Teiger, Emmanuel; Laskar, Marc; Vahanian, Alec; Gilard, Martine

doi:10.1136/heartjnl-2013-305314

Cited by 191 publications

(136 citation statements)

References 30 publications

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“…Studies of EuroSCORE II show an area under the receiver-operating characteristic curve of only 0.7 20 and 0.59 from the French registry. 21 In our study, Logistic EuroSCORE was a predictor of 30-day outcome only when it was extremely high (≥40). This relationship with procedural outcome is reflected in the survival curves, which for Logistic EuroSCORE >40 separate sharply during early follow-up.…”

Section: Discussionmentioning

confidence: 98%

Transcatheter Aortic Valve Implantation in the United Kingdom

et al. 2015

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Background-We assessed trends in the performance of transcatheter aortic valve implantation in the United Kingdom from the first case in 2007 to the end of 2012. We analyzed changes in case mix, complications, outcomes to 6 years, and predictors of mortality. Methods and Results-Annual cohorts were examined. Mortality outcomes were analyzed in the 92% of patients from England and Wales for whom independent mortality tracking was available. A total of 3980 transcatheter aortic valve implantation procedures were performed. In successive years, there was an increase in frequency of impaired left ventricular function, but there was no change in Logistic EuroSCORE. Overall 30-day mortality was 6.3%; it was highest in the first cohort (2007)(2008), after which there were no further significant changes. One-year survival was 81.7%, falling to 37.3% at 6 years. Discharge by day 5 rose from 16.7% in 2007 and 2008 to 28% in 2012. The only multivariate preprocedural predictor of 30-day mortality was Logistic EuroSCORE ≥40. During long-term follow-up, multivariate predictors of mortality were preprocedural atrial fibrillation, chronic obstructive pulmonary disease, creatinine >200 μmol/L, diabetes mellitus, and coronary artery disease. The strongest independent procedural predictor of long-term mortality was periprocedural stroke (hazard ratio=3.00; P<0.0001). Nonfemoral access and postprocedural aortic regurgitation were also significant predictors of adverse outcome. Conclusions-We analyzed transcatheter aortic valve implantation in an entire country, with follow-up over 6 years.Although clinical profiles of enrolled patients remained unchanged, longer-term outcomes improved, and patients were discharged earlier. Periprocedural stroke, nonfemoral access, and postprocedural aortic regurgitation are predictors of adverse outcome, along with intrinsic patient risk factors. Since then, another randomized trial 4 and several registries have reported the uptake of TAVI, both valve specific 5-9 and country based.10-15 Nevertheless, there is still a paucity of data relating to long-term outcomes. Here, we assess the patterns of changing indications, clinical characteristics, procedural details, and outcomes from the UK TAVI registry, which has recorded information for every single patient treated by TAVI, amounting to a total of 3980 procedures by the end of 2012. Clinical Perspective on p 1190Methods TAVI was first performed in the United Kingdom in 2007, and by December 2012, 33 centers were active TAVI centers. The early development of UK TAVI up to 2009 has been described. 15 Patient eligibility for a procedure was decided in each center by a multidisciplinary team composed of interventional cardiologists, imaging cardiologists, cardiothoracic surgeons, and anesthetists. The main valve technologies available were the Edwards Sapien and later the Sapien XT, as well as the Medtronic CoreValve. A transfemoral approach was the default strategy for all patients. For those treated with the Medtronic CoreValve, there was later expe...

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Section: Discussionmentioning

confidence: 98%

Transcatheter Aortic Valve Implantation in the United Kingdom

et al. 2015

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“…Also in accordance with these results, Barbash et al 19 showed the presence of apical wall motion abnormalities in about one third of the patients treated through the TA approach, which translated into a lower LVEF at follow-up. While the poorer outcomes associated with the TA approach have been mainly related to the higher risk profile of the patients treated through this approach (usually patients with inadequate iliofemoral access) 20 , the TA approach was found to be an independent predictor of mortality in two large TAVI studies (FRANCE-2 and the UK TAVI Registry) 21,22 as well as in a recent meta-analysis 23 . The present study showing that this approach is systematically associated with significant irreversible myocardial injury suggests that the loss of ~5% of the myocardium associated with this approach (>1 g of necrotic mass in all cases) may contribute to these poorer clinical outcomes.…”

Section: Figure 4 Degree and Extent Of Myocardial Necrosis At The Apmentioning

confidence: 99%

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Ribeiro¹,

Larose²,

Ricapito³

et al. 2015

EuroIntervention

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Aims: The aim of this study was to evaluate the presence, localisation and extent of myocardial injury as determined by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging in patients undergoing transcatheter aortic valve implantation (TAVI). Methods and results:A total of 37 patients, who underwent successful TAVI with a balloon-expandable valve (transapical [TA], n=11; non-TA, n=26), were included. Cardiac biomarker (CK-MB and cTnT) levels were determined at baseline and following TAVI. CMR was performed within a week before and within 30 days following TAVI. Some increase in cardiac biomarkers was detected in 97% of the patients as determined by a rise in cTnT, and in 49% of the patients as determined by a rise in CK-MB. Following TAVI, no new myocardial necrosis defects were observed with the non-TA approach. Nonetheless, all patients who underwent TAVI through the TA approach had new focal myocardial necrosis in the apex, with a median myocardial extent and necrotic mass of 5% [2.0-7.0] and 3.5 g [2.3-4.5], respectively.Conclusions: Although some increase in cardiac biomarkers of myocardial injury was systematically detected following TAVI, new myocardial necrosis as evaluated by CMR was observed only in patients undergoing the procedure through the TA approach, involving ~5% of the myocardium in the apex. KEYWORDS• cardiac biomarkers • cardiac magnetic resonance imaging • late gadolinium enhancement • myocardial injury • transcatheter aortic valve implantation

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“…6,7 Recent studies have developed parsimonious prediction models to facilitate patient selection and counseling for TAVR. [8][9][10] However, a TAVR risk model customized for institutional performance assessment was not previously available.…”

Section: Editorial See P 498mentioning

confidence: 99%

Variation in Hospital Risk–Adjusted Mortality Rates Following Transcatheter Aortic Valve Replacement in the United States

O’Brien

Cohen

Rumsfeld

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background-The use of transcatheter aortic valve replacement (TAVR) to treat aortic stenosis in the United States isgrowing, yet little is known about the variation in procedural outcomes in community practice. We developed a TAVR inhospital mortality risk model and used it to quantify variation in mortality rates across United States (US) TAVR centers. Methods and Results-We analyzed data from 22 248 TAVR procedures performed at 318 sites participating in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (November 2011 to October 2014). A Bayesian hierarchical model was developed to estimate hospital-specific risk-adjusted mortality rates adjusting for 40 patient baseline factors. A total of 1130 in-hospital deaths (5.1%) were observed. Reliability-adjusted risk-adjusted mortality rate estimates ranged from 3.4% to 7.7% with an interquartile range of 4.8% to 5.4%. A patient's predicted odds of dying was 80% higher if treated by a hospital 1 standard deviation above the mean compared with a hospital 1 standard deviation below the mean (odds ratio =1.8; 95% credible interval, 1.4%-2.2%). Conclusions-Risk modeling of TAVR in-hospital mortality revealed variation in risk-adjusted mortality rates during the US early commercial experience. Transcatheter Valve Therapy Registry analyses using this model will support research, feedback reporting, and the identification of factors associated with quality. (Circ Cardiovasc Qual Outcomes. 2016;9:560-565.

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Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score

Cited by 191 publications

References 30 publications

Transcatheter Aortic Valve Implantation in the United Kingdom

Transcatheter Aortic Valve Implantation in the United Kingdom

Myocardial injury following transcatheter aortic valve implantation: insights from delayed-enhancement cardiovascular magnetic resonance

Variation in Hospital Risk–Adjusted Mortality Rates Following Transcatheter Aortic Valve Replacement in the United States

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