Transcatheter aortic valve implantation complexity score

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Health services research

Background:

• Rising demand for transcatheter aortic valve implantation (TAVI) necessitates efficient service delivery.
• Limited cardiac catheterisation laboratory time is a key constraint for increasing TAVI capacity.
• A new TAVI complexity scoring system (TEX score) has been developed to assist with case selection and list planning.

Purpose of the Study:

• To validate the TAVI ComplEXity (TEX) score.
• To assess the correlation between TEX score-based complexity levels and TAVI procedural outcomes.
• To determine if the TEX score can aid in optimizing TAVI scheduling.

Main Methods:

• Retrospective analysis of 1034 consecutive TAVI cases (June 2021 - October 2023).
• Patients were stratified into three complexity levels (1-low, 2-intermediate, 3-high) using the TEX score based on clinical and anatomical variables.
• Comparisons were made regarding procedural duration, Valve Academic Research Consortium 3 (VARC-3) technical success, device success, and early safety across complexity levels.

Main Results:

• The study included 1034 patients: 56.3% level 1, 36.5% level 2, and 7.3% level 3 complexity.
• Significant differences observed in procedural duration (73.7 min vs 85.6 min vs 136 min; p<0.001) across complexity levels.
• Increasing complexity correlated with reduced VARC-3 technical success (97.9% vs 96.6% vs 92%; p<0.05) and device success (96.2% vs 92.3% vs 86.6%; p<0.001).

Conclusions:

• The TEX score is a simple, effective tool for stratifying TAVI patient complexity into three levels.
• Higher complexity levels identified by the TEX score are associated with longer procedural durations and lower VARC-3 success rates.
• The TEX score can be a valuable tool for scheduling TAVI procedures and optimizing resource allocation.