Predicting Early and Late Mortality After Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Geriatric Medicine
• Interventional Cardiology

Background:

• Limited research exists on novel comorbidity, frailty, and disability indices impacting transcatheter aortic valve replacement (TAVR) outcomes.
• Assessing comprehensive patient risk is crucial for TAVR, a procedure for severe aortic stenosis.

Purpose of the Study:

• To develop a simple scoring system incorporating standard and novel predictors for TAVR outcomes.
• To evaluate the effectiveness of this score in stratifying mortality risk in TAVR patients.

Main Methods:

• Analysis of 3,687 patients from the Medtronic CoreValve U.S. Pivotal Trial, divided into derivation (n=2,482) and validation (n=1,205) cohorts.
• Identification of predictors for 30-day and 1-year all-cause mortality.
• Development of a risk score based on multivariable predictors.

Main Results:

• Overall mortality rates were 5.8% at 30 days and 22.8% at 1 year.
• Key predictors for 30-day mortality included home oxygen use, assisted living, low albumin, and age >85.
• Predictors for 1-year mortality included home oxygen use, low albumin, recent falls, high STS PROM, and high Charlson comorbidity score.
• The developed scoring system effectively stratified patients into low, moderate, and high-risk groups, showing a 3-fold difference in mortality at 30 days and 1 year.

Conclusions:

• A novel scoring system, emphasizing new outcome predictors, accurately stratifies early and late mortality in high-risk TAVR candidates.
• This score can assist heart teams in selecting appropriate patients for TAVR, optimizing procedural outcomes.