Calculating Risk for Poor Outcomes After Transcatheter Aortic Valve Replacement

To outline the tools available to help understand the risk of transcatheter aortic valve replacement (TAVR) and the gaps in knowledge regarding TAVR risk estimation.

Review of the literature.

Two models developed and validated by the American College of Cardiology can be used to estimate the risk of short-term mortality, a 6-variable in-hospital model designed for clinical use and a 41-variable 30- day model designed primarily for site comparisons and quality improvement. Importantly, neither model should be used to inform the choice of TAVR versus surgical aortic valve replacement. Regarding long-term outcomes, a risk model to estimate risk of dying or having a persistently poor quality of life at 1 year after TAVR has been developed and validated. Factors that most significantly increase a patient's risk for poor outcomes are very poor functional status prior to TAVR, requiring home oxygen, chronic renal insufficiency, atrial fibrillation, dependencies in activities of daily living, and dementia. If a patient has ≥ 2 or 3 major risk factors for a poor outcome, this risk and the uncertainty about the degree of recovery expected after TAVR should be discussed with the patient (and family).

It is important to understand the patient factors that most strongly drive risk of poor outcomes after TAVR and use this information to set appropriate expectations for recovery.