Article Text

PDF
Original article
Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score
  1. Bernard Iung1,2,
  2. Cédric Laouénan2,3,
  3. Dominique Himbert1,
  4. Hélène Eltchaninoff4,
  5. Karine Chevreul5,
  6. Patrick Donzeau-Gouge6,
  7. Jean Fajadet7,
  8. Pascal Leprince8,
  9. Alain Leguerrier9,
  10. Michel Lièvre10,
  11. Alain Prat11,
  12. Emmanuel Teiger12,
  13. Marc Laskar13,
  14. Alec Vahanian1,2,
  15. Martine Gilard14,
  16. for the FRANCE 2 Investigators
  1. 1Cardiology Department, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
  2. 2University Paris Diderot, Sorbonne Paris Cité, Paris, France
  3. 3Biostatistic Department, AP-HP, Bichat Hospital, Paris, France
  4. 4Cardiology Department, Hôpital Charles Nicolle, University of Rouen, INSERM Unité 1096, Rouen, France
  5. 5URC Eco and UPEC EA 4393, AP-HP, Paris, France;
  6. 6Institut Jacques Cartier, Massy, France
  7. 7Clinique Pasteur, Toulouse, France
  8. 8Cardiac Surgery Department, AP-HP, Hôpital Pitié-Salpetrière, Paris, France
  9. 9Cardiac Surgery Department, CHU Pontchaillou, Rennes, France
  10. 10Université Lyon 1, Lyon, France
  11. 11Cardiac Surgery Department, Hôpital Cardiologique, CHU, Lille, France
  12. 12Cardiology Department, AP-HP, Hôpital Henri Mondor, Créteil, France
  13. 13Cardiovascular Surgery Department, Hôpital Dupuytren, CHU, Limoges, France
  14. 14Cardiology Department, Hôpital de la Cavale Blanche, CHU, Brest, France
  1. Correspondence to Professor Bernard Iung, Cardiology Department, Bichat Hospital, 46 rue Henri Huchard, Paris 75877, Cedex 18, France; bernard.iung{at}bch.aphp.fr

Abstract

Objective Decision making for intervention in symptomatic aortic stenosis should balance the risks of surgery and of transcatheter aortic valve implantation (TAVI). We identified the factors associated with early mortality after TAVI and aimed to develop and validate a simple risk score.

Methods A population of 3833 consecutive patients was randomly split into two cohorts comprising 2552 and 1281 patients, used respectively to develop and validate a scoring system predicting 30-day or in-hospital mortality.

Results TAVI was performed using the Edwards Sapien prosthesis in 2551 (66.8%) patients and the Medtronic Corevalve in 1270 (33.2%). Approach was transfemoral in 2801 (73.4%) patients, transapical in 678 (17.8%), subclavian in 219 (5.7%) and other in 117 (3.1%). Early mortality was 10.0% (382 patients). A multivariate logistic model identified the following predictive factors of early mortality: age ≥90 years, body mass index <30 Kg/m2, New York Heart Association class IV, pulmonary hypertension, critical haemodynamic state, ≥2 pulmonary oedemas during the last year, respiratory insufficiency, dialysis and transapical or other (transaortic and transcarotid) approaches. A 21-point predictive score was derived. C-index was 0.67 for the score in the development cohort and 0.59 in the validation cohort. There was a good concordance between predicted and observed 30-day mortality rates in the development and validation cohorts.

Conclusions Early mortality after TAVI is mainly related to age, the severity of symptoms, comorbidities and transapical approach. A simple score can be used to predict early mortality after TAVI. The moderate discrimination is however a limitation for the accurate identification of high-risk patients.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles