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Related Experiment Video

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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German

Georg Wolff1, Jasmin Shamekhi2, Baravan Al-Kassou2

  • 1Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany. Georg.Wolff@med.uni-duesseldorf.de.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|August 28, 2020
PubMed
Summary

Current surgical risk models show mediocre performance for predicting 30-day mortality in transcatheter aortic valve replacement (TAVR) patients. New models are needed to improve risk stratification for TAVR procedures.

Keywords:
EuroSCOREGAVSMortalityRisk predictionTAVITAVR

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Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Surgical Outcomes Research

Background:

  • Risk prediction models are crucial for guiding decisions in transcatheter aortic valve replacement (TAVR).
  • Existing TAVR-specific models aim to enhance risk stratification, but their comparative effectiveness is unclear.

Purpose of the Study:

  • To conduct a comparative validation of six risk models for predicting 30-day mortality in TAVR patients.
  • To assess the performance of surgical and TAVR-specific risk scores in a large German cohort.

Main Methods:

  • Analysis of 2946 patients undergoing transfemoral (TF) or transapical (TA) TAVR from 2008-2018.
  • Evaluation of six risk models: LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, and GAVS-II.
  • Assessment of discrimination (c-indices) and calibration for predicting 30-day mortality.

Main Results:

  • Observed 30-day mortality was 3.7% (3.2% TF, 7.5% TA).
  • Risk model predictions varied widely, from 5.8% (OBSERVANT) to 23.4% (LogES I).
  • Discrimination (c-indices) ranged from 0.60 to 0.67, with no significant differences between models or approaches.
  • All models, particularly LogES I, overestimated mortality risk, especially in high-risk patients.

Conclusions:

  • Both surgical and TAVR-specific risk models demonstrated mediocre performance in predicting 30-day mortality.
  • There is a clear need for the development of new or updated risk models to improve TAVR patient stratification.