Surgical Mortality Risk Scores in Transcatheter Aortic Valve Implantation: Is Their Early Predictive Value Still Strong?

Autor: Fortunato Iacovelli, Francesco Loizzi, Alessandro Cafaro, Osvaldo Burattini, Luigi Salemme, Angelo Cioppa, Francesco Rizzo, Chiara Palmitessa, Maurizio D’Alessandro, Daniele De Feo, Armando Pucciarelli, Emanuela De Cillis, Vincenzo Pestrichella, Gaetano Contegiacomo, Tullio Tesorio, Alessandro Santo Bortone
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Journal of Cardiovascular Development and Disease, Vol 10, Iss 6, p 244 (2023)
Druh dokumentu: article
ISSN: 2308-3425
DOI: 10.3390/jcdd10060244
Popis: Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.
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