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Updated: Sep 2, 2025
06:02
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
156
Comorbidities may offset expected improved survival after transcatheter aortic valve replacement.
Pierre Lantelme1, Matthieu Aubry1, Jacques Chan Peng2
1Service de Cardiologie, Hôpital de la Croix-Rousse et Hôpital Lyon Sud, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France.
European Heart Journal Open
|August 3, 2022
Summary
Transcatheter aortic valve replacement (TAVR) offers survival benefits for severe aortic stenosis patients with good or intermediate prognoses. However, TAVR’s benefit is limited in patients with high comorbidity burden, indicating futility in poor prognosis cases.
Area of Science:
- Cardiology
- Geriatric Medicine
- Health Services Research
Background:
- Severe aortic stenosis (AS) management involves transcatheter aortic valve replacement (TAVR).
- Patient comorbidities can significantly impact survival outcomes post-TAVR.
- Assessing comorbidity burden is crucial for predicting TAVR efficacy.
Purpose of the Study:
- To investigate the relationship between patient comorbidities and the survival benefit of TAVR.
- To determine if comorbidity scores can predict TAVR outcomes in severe AS patients.
- To stratify TAVR's survival benefit based on prognostic categories.
Main Methods:
- Pooled analysis of two European cohorts (TAVR-treated and medically treated severe AS patients).
- Utilized calcification prognostic impact (CAPRI) and Charlson scores to assess comorbidities.
- Developed a three-level prognostic scale (good, intermediate, poor) based on CAPRI and Charlson scores.
- Stratified TAVR survival benefit across prognostic categories.
Main Results:
- CAPRI and Charlson scores independently predicted 1-year all-cause mortality in severe AS patients.
- TAVR demonstrated a significant survival benefit in patients with good and intermediate prognoses (HR 0.36 and 0.32, respectively).
- The survival benefit of TAVR was not statistically significant in patients with a poor prognosis (HR 0.65).
Conclusions:
- High comorbidity burden, indicated by CAPRI and Charlson scores, is associated with poor survival post-TAVR.
- TAVR is less effective in improving survival for patients with a high comorbidity burden (poor prognosis).
- Prognostic scoring systems are essential for identifying patients unlikely to benefit from TAVR.
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