Performance of contemporary surgical risk scores for transcatheter aortic valve implantation: A meta-analysis

Wang, Tom Kai Ming; Wang, Michael Tzu Min; Gamble, Greg; Webster, Mark; Ruygrok, Peter

doi:10.1016/j.ijcard.2016.12.188

Cited by 36 publications

(23 citation statements)

References 31 publications

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“…Surgical risk models performed similar to expectations [13]: Discrimination analysis essentially showed similar performance of STS PROM [10], LogES I [7,8] and ES II [9] models. None could even remotely match discrimination performance in their original surgical patient cohorts.…”

Section: Graphical Analysis Of Calibration Is Displayed Insupporting

confidence: 59%

“…Classical surgical risk models (LogES I, STS PROM, ES II) have well-known limitations in TAVR [13]. LogES I is not recommended for use in TAVR anymore 1, we included the model for historical comparisons.…”

Section: Graphical Analysis Of Calibration Is Displayed Inmentioning

confidence: 99%

“…Cardiovascular societies recommend clinical decision-making for TAVR within the Heart Team [1,2], assisted by the use of statistical risk scoring models for individual patient risk stratification. Classical surgical risk models such as logistic EuroSCORE I (LogES I) [7,8], its update EuroSCORE II (ES II) [9], or the Society of Thoracic Surgeons Predicted Risk of Mortality model (STS PROM) [10] are routinely used to gauge operative risk; however, they are known to overestimate mortality risk in TAVR [11][12][13]. Several TAVR-specific risk assessment models have been developed from national registry databases to optimize the predictive performance in the context of TAVR [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients

et al. 2020

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Background Surgical risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR). New and updated TAVR-specific models have been developed to improve risk stratification; however, the best option remains unknown. Objective To perform a comparative validation study of six risk models for the prediction of 30-day mortality in TAVR Methods and results A total of 2946 patients undergoing transfemoral (TF, n = 2625) or transapical (TA, n = 321) TAVR from 2008 to 2018 from the German Rhine Transregio Aortic Diseases cohort were included. Six surgical and TAVR-specific risk scoring models (LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, GAVS-II) were evaluated for the prediction of 30-day mortality. Observed 30-day mortality was 3.7% (TF 3.2%; TA 7.5%), mean 30-day mortality risk prediction varied from 5.8 ± 5.0% (OBSERVANT) to 23.4 ± 15.9% (LogES I). Discrimination performance (ROC analysis, c-indices) ranged from 0.60 (OBSERVANT) to 0.67 (STS PROM), without significant differences between models, between TF or TA approach or over time. STS PROM discriminated numerically best in TF TAVR (c-index 0.66; range of c-indices 0.60 to 0.66); performance was very similar in TA TAVR (LogES I, ES II, FRANCE-2 and GAVS-II all with c-index 0.67). Regarding calibration, all risk scoring models-especially LogES I-overestimated mortality risk, especially in high-risk patients. Conclusions Surgical as well as TAVR-specific risk scoring models showed mediocre performance in prediction of 30-day mortality risk for TAVR in the German Rhine Transregio Aortic Diseases cohort. Development of new or updated risk models is necessary to improve risk stratification.

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Section: Graphical Analysis Of Calibration Is Displayed Insupporting

confidence: 59%

Section: Graphical Analysis Of Calibration Is Displayed Inmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients

et al. 2020

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“…The sample size did not allow for subgroup analysis to differentiate outcome in either diabetic or non-diabetic patients and this question should be addressed in a specifically designed study. The sample size could also explain that the trend observed between the risk of MAEs and the Euroscore value did not reach the statistical significance although a weak but statistically significant association was reported between Euroscore and mortality after TAVI in some previously published studies [35, 36]. Second, glycemic variability was not determined using a continuous monitoring system and could be underestimated [3].…”

Section: Discussionmentioning

confidence: 99%

Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis

Besch

Pili-Floury

Morel

et al. 2019

Cardiovasc Diabetol

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BackgroundGlycemic variability is associated with worse outcomes after cardiac surgery, but the prognosis value of early glycemic variability after transcatheter aortic valve implantation is not known. This study was therefore designed to analyze the prognosis significance of post-procedural glycemic variability within 30 days after transcatheter aortic valve implantation.MethodsA post hoc analysis of patients from our center included in the FRANCE and FRANCE-2 registries was conducted. Post-procedural glycemic variability was assessed by calculating the mean daily δ blood glucose during the first 2 days after transcatheter aortic valve implantation. Major complications within 30 days were death, stroke, myocardial infarction, acute heart failure, and life-threatening cardiac arrhythmias.ResultsWe analyzed 160 patients (age (median [interquartile] = 84 [80–88] years; diabetes mellitus (n) = 41 (26%) patients; logistic Euroscore = 20 [12–32]). The median value of mean daily δ blood glucose was 4.3 mmol l−1. The rate of major complications within 30 days after procedure among patients with the lowest quartile of glycemic variability was 12%, increasing from 12 to 26%, and 39% in the second, third, and fourth quartiles, respectively. In multivariate analysis, glycemic variability was independently associated with an increased risk of major complications within 30 days after the procedure (odds ratio [95% CI] = 1.83 [1.19–2.83]; p = 0.006).ConclusionsThis study showed that post-procedural glycemic variability was associated with an increased risk of major complications within 30 days after transcatheter aortic valve implantation.Trial registration Clinical trial registration number https://www.clinicaltrials.gov/; identifier: NCT02726958; date: April 4th, 2016

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“…Despite surgical aortic valve replacement remains the treatment of choice for symptomatic aortic valve disease, the transcatheter aortic valve replacement (TAVR) has become a valid alternative in selected high-risk patients. [1][2][3][4][5][6][7][8] Conversely, because of the complex anatomy, the aortic root disease, combined or not with a valve dysfunction, is still not addressed with transcatheter techniques and patients at high risk for surgery can only undergo TAVR without root replacement or standard surgical procedures requiring cardiopulmonary bypass, root replacement, and coronary reimplantation.…”

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confidence: 99%

Suitability of 3D-Printed Root Models for the Development of Transcatheter Aortic Root Repair Technologies

et al. 2019

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Transcatheter aortic root repair (TARR) is still not available because of the complex anatomy. In order to develop future TARR technologies, a human-derived bench test model is required before performing animal tests. For this purpose, we aimed to validate computed tomography (CT)-derived 3Dprinted root models for TARR technologies. Four human CT-derived roots were printed using different resins: Visijet M3 Crystal, Photopolymer gel SUP705, Formlabs flexible resin, and Materialise HeartPrint Flex. A stress test was performed using a 26-mm balloon-expandable Sapien valve deployed in aortic position. The too rigid Visijet M3 Crystal was not tested. Among the others, all but one (HeartPrint Flex) ruptured during the test showing low wall resistances. Further tests were then performed in two roots made of HeartPrint Flex resin. The anatomic validation was performed comparing human CT scanderived 3D reconstructions and CT scan measurements: a mean difference of 0.57 ± 0.4 mm for aortic annulus diameter and for the distance between the aortic annulus and the coronary ostia was measured. Concerning the coronary arteries, they are of paramount importance for new TARR technologies, and therefore, we tested the coronary flows of the HeartPrint Flex root at different pressure levels. At 60 mm Hg, right and left mean adjusted coronary flows were 471 and 663 ml/min; at 80 mm Hg, right and left mean coronary flows were 551 and 777 ml/min; and at 100 mm Hg, right and left mean coronary flows were 625 and 858 ml/min. In our study, 3D-printed root models correlate well with human anatomy and guarantee physiologic coronary flows for TARR technologies.Transcatheter aortic root repair (TARR) is still not available because of the complex anatomy. In order to develop future TARR technologies, a human-derived bench test model is required before performing animal tests. For this purpose, we aimed to validate computed tomography (CT)-derived 3D-printed root models for TARR technologies. Four human CT-derived roots were printed using different resins: Visijet M3 Crystal, Photopolymer gel SUP705, Formlabs flexible resin, and Materialise HeartPrint Flex. A stress test was performed using a 26-mm balloon-expandable Sapien valve deployed in aortic position. The too rigid Visijet M3 Crystal was not tested. Among the others, all but one (HeartPrint Flex) ruptured during the test showing low wall resistances. Further tests were then performed in two roots made of HeartPrint Flex resin. The anatomic validation was performed comparing human CT scan-derived 3D reconstructions and CT scan measurements: a mean difference of 0.57 ± 0.4 mm for aortic annulus diameter and for the distance between the aortic annulus and the coronary ostia was measured. Concerning the coronary arteries, they are of paramount importance for new TARR technologies, and therefore, we tested the coronary flows of the HeartPrint Flex root at different pressure levels. At 60 mm Hg, right and left mean adjusted coronary flows were 471 and 663 ml/min; at 80 mm Hg, right and left m...

show abstract

Performance of contemporary surgical risk scores for transcatheter aortic valve implantation: A meta-analysis

Cited by 36 publications

References 31 publications

Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients

Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients

Impact of post-procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis

Suitability of 3D-Printed Root Models for the Development of Transcatheter Aortic Root Repair Technologies

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