Predictors of clinical outcome following transcatheter aortic valve implantation: a prospective cohort study

Abstract

ObjectiveIn recent years, transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with symptomatic aortic valve stenosis considered to be at increased or high surgical risk. The aim of this study was to identify predictors of postoperative adverse events in older adults undergoing TAVI.MethodsA prospective observational cohort study of patients who were referred to a geriatric outpatient clinic for a geriatric assessment prior to TAVI was conducted. The outcomes were mortality and hospital readmission within 3 months of TAVI and the occurrence of major postoperative complications during hospitalisation according to the Clavien-Dindo classification. These three outcomes were also combined to a composite outcome. Univariate and multivariate logistic regression analyses were performed to identify predictors of the outcomes and composite outcome of adverse events.ResultsThis cohort included 490 patients who underwent TAVI (mean age 80.7±6.2 years, 47.3% male). Within 3 months of TAVI, 19 (3.9%) patients died and 46 (9.4%) patients experienced a hospital readmission. A total of 177 (36.1%) patients experienced one or more major complications according to the Clavien-Dindo classification during hospitalisation and 193 patients (39.4%) experienced the composite outcome of adverse events. In multivariate analyses, cognitive impairment was identified as an independent predictor of major postoperative complications (OR 2.16; 95% CI 1.14 to 4.19) and the composite outcome of adverse events (OR 2.40; 95% CI 1.21 to 4.79). No association was found between the other variables and the separate outcomes and composite outcome.ConclusionCognitive impairment is associated with postoperative adverse events in older patients undergoing TAVI. Therefore, it is important to screen for cognitive impairment prior to TAVI and it is recommended to include this in current TAVI guidelines.

Spatial analysis and factors associated with transcatheter aortic valve implantation in Portugal: a retrospective analysis from 2015 to 2017

“…In contrast, many patients with lower CCI classification have undergone in SAVR. These results are consistent with the literature,19 20 22 32 33 which suggests that TAVI is usually performed more often in patients with grater frailty.…”

“…Therefore, the results should be interpreted as associations between the variables. Finally, the CCI is represented by a specific group of comorbidities commonly used in observational studies 19 20 22 32. Other important comorbidities might influence AS severity and medical decision on therapeutic choice might not be considered.…”

“…presents the weights used to calculate the CCI. The CCI was analysed in two ways: as an index, and as a categorical variable (cut-off point≥3) 19 21 22. Additionally, the relation between procedures and the pathologies that compose the index were evaluated separately, as many of the pathologies that comprise the index are common among AS patients.…”

Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

“…However, a strong positive association was found between high post-TAVR hs-cTnT levels and an increase in midterm mortality. As a strong predictor of all-cause mortality and cardiovascular mortality in patients with cardiovascular disease complicated with PH [95], hs-TnT levels not only show strong correlations with hemodynamics [96], but also appear to be a promising indicator of events after TAVR [97,98]. However, this evidence requires further investigation in large clinical trials [99].…”

Predictors of postoperative negative outcomes in patients undergoing transcatheter aortic valve implantation

“…Planning for TAVI procedures, particularly patient selection, has been found to lower rates of complications, resulting in shorter hospitalisation, lower costs and fewer deaths (Toggweiler 2014). An emerging strategy for patients undergoing TAVI is to identify preoperative factors predictive of post-operative adverse outcomes (Dautzenberg et al 2021).…”