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Published on: August 8, 2025
Transcatheter Aortic Valve Implantation in Patients at Extremely High Risk of Perioperative Mortality
Insights
Transcatheter aortic valve implantation (TAVI) is safe for high-risk patients, even with predicted high mortality. Individualized risk assessment is crucial for optimal outcomes in TAVI procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve implantation (TAVI) is a key treatment for high-risk patients ineligible for surgical aortic valve replacement.
- The logistic EuroSCORE I, despite debate, remains a primary tool in Europe for identifying high-risk cardiac surgery patients.
- This study utilized the logistic EuroSCORE I to stratify patients undergoing TAVI based on predicted perioperative mortality risk.
Purpose of the Study:
- To evaluate the safety and efficacy of TAVI in patients with an extremely high predicted risk of perioperative mortality (EuroSCORE >40%).
- To compare perioperative complications, short-term mortality, and major adverse cardiac and cerebrovascular events between extremely high-risk and lower-risk TAVI patient groups.
- To assess the necessity of individualized risk evaluation in the context of TAVI procedures.
Main Methods:
- A single-centre study involving 319 consecutive patients undergoing transapical or transaortic TAVI between September 2008 and December 2012.
- Patients were divided into two groups: extremely high-risk (EuroSCORE >40%, n=90) and lower-risk (EuroSCORE <40%, n=229).
- Excluded were patients who underwent combined hybrid procedures or transfemoral TAVI.
Main Results:
- 30-day mortality was 12.2% in the extremely high-risk group versus 6.6% in the lower-risk group (p=0.08).
- No significant differences were observed in stroke rates (3.3% vs 0.4%, p=0.07) or acute kidney injury stage 3 (11.1% vs 5.2%, p=0.32).
- The lower-risk group showed significantly lower rates of cardiopulmonary bypass (3.9% vs 11.1%, p=0.02), conversion to sternotomy (1.3% vs 5.6%, p=0.04), shorter ventilation times, and reduced ICU stays.
Conclusions:
- TAVI is a safe procedure for patients with extremely high predicted perioperative mortality risk.
- The findings support the use of TAVI even in complex, high-risk patient populations.
- Individualized risk assessment is essential for determining appropriate treatment strategies in TAVI candidates.
Background And Aim Of The Study:
Transcatheter procedures are considered the therapy of choice for high-risk patients who are not eligible for surgical aortic valve replacement. Although its utility is debated, the logistic EuroSCORE I is still the most frequently used risk calculator for cardiac surgery in Europe, and was used in the present study to identify patients with an extremely high risk of predicted perioperative mortality.
Methods:
This single-centre study included 319 consecutive patients who underwent transapical or transaortic transcatheter aortic valve implantation (TAVI) between September 2008 and December 2012. Combined hybrid procedures and transfemoral TAVI patients were excluded. Those patients predicted to have an excessively high risk of perioperative mortality (EuroSCORE >40%, n = 90) were compared to those with a lower calculated risk (EuroSCORE <40%, n = 229) with respect to perioperative complications, short-term-mortality and major adverse cardiac and cerebrovascular events.
Results:
The 30-day mortality was 12.2% (n = 11) in the extremely high-risk group, and 6.6% (n = 15) in the lower-risk group (p = 0.08). There were no significant differences in the stroke rate (3.3% versus 0.4%, p = 0.07) or the incidence of acute kidney injury stage 3 (11.1% versus 5.2%, p = 0.32). The establishment of cardiopulmonary bypass (3.9% versus 11.1%, p = 0.02), conversion to sternotomy (1.3% versus 5.6%, p = 0.04), mean ventilation time (15.2 h versus 43.5 h, p = 0.007) and length of intensive care unit stay (2.9 days versus 6.8 days, p <0.001) were all significantly lower in the lower-risk group.
Conclusion:
The data acquired verified that TAVI is a safe procedure, even in patients with an extremely high predicted risk of perioperative mortality and major adverse cardiac and cerebrovascular events. Furthermore, the analysis substantiated the need for individualized risk evaluation.
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