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CO2 Gap Alone Is Not a Prognostic Marker for 28-Day Survival of Patients Undergoing a Transcatheter Aortic Valve

Lisa Thiehoff1, Julia Alexandra Simons1, Steffen B Wiegand2

  • 1Department of Anesthesiology, University Hospital Aachen, 52074 Aachen, Germany.

Journal of Clinical Medicine
|July 12, 2025
PubMed

Insights

The venous-to-arterial carbon dioxide (CO2) gap is not a reliable predictor of 28-day survival in transcatheter aortic valve replacement (TAVR) patients. While higher CO2 gaps were observed in non-survivors, it did not significantly correlate with cardiac function or lactate levels.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Medical Diagnostics

Background:

  • The venous-to-arterial partial pressure of carbon dioxide (CO2) difference, or CO2 gap, is a potential indicator of cardiac output and patient outcomes.
  • Transcatheter aortic valve replacement (TAVR) is a procedure where assessing prognostic markers is crucial for patient management.

Purpose of the Study:

  • To evaluate the prognostic value of the CO2 gap for 28-day survival in TAVR patients.
  • To investigate the relationship between the CO2 gap, cardiac function (left ventricular ejection fraction), and lactate levels in TAVR patients.

Main Methods:

  • A prospective cohort study involving 50 TAVR patients.
  • Blood gas parameters, including the CO2 gap, were measured at five time points.
  • Patients were stratified by left ventricular ejection fraction (LV-EF) and survival status.

Main Results:

  • Receiver operating characteristic (ROC) analysis showed limited prognostic value of the CO2 gap for 28-day survival.
  • The CO2 gap was significantly higher in non-survivors (11.1 mmHg) compared to survivors (6.8 mmHg) (p=0.039).
  • No significant correlation was found between the CO2 gap and lactate levels, except at one time point in the cardiac group. CO2 content was higher in survivors at one time point.

Conclusions:

  • The CO2 gap did not prove to be a reliable prognostic marker for 28-day survival in the TAVR patient cohort.
  • Further research is warranted to fully elucidate the clinical significance and utility of the CO2 gap in TAVR patients.

Keywords:
CO2 contentratio of venous-to-arterial CO2 difference to arterial-to-venous O2 contenttranscatheter aortic valve replacementvenous-to-arterial carbon dioxide difference

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