Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

Piazza, Nicolò; Wenaweser, Peter; Gameren, Menno van; Pilgrim, Thomas; Tsikas, Apostolos; Otten, A; Nuis, Rutger Jan; Onuma, Yoshinobu; Cheng, Jin M.; Kappetein, Arie Pieter; Boersma, Eric; Jüni, Peter; Jaegere, Peter de; Windecker, Stephan; Serruys, Patrick W.

doi:10.1016/j.ahj.2009.11.026

Cited by 151 publications

(95 citation statements)

References 22 publications

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“…Further baseline and procedural characteristics of this patient population have been previously described (Table 1) (14). In line with other recent studies (11,12,16), the logistic EuroSCORE of our patient cohort was about three times higher than the STS score.…”

Section: Resultssupporting

confidence: 74%

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Patsalis

Konorza

Al–Rashid

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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P. Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality. Am J Physiol Heart Circ Physiol 304: H1023-H1028, 2013. First published January 11, 2013; doi:10.1152/ajpheart.00807.2012.-A relevant (at least moderate) paravalvular regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is found in up to 20% of cases and associated with increased mortality. The ratio of the diastolic over the systolic pressure time integral (DPTI:SPTI) has been proposed to reflect an estimate of myocardial oxygen supply versus demand and the propensity for myocardial ischemia. We have now evaluated the potential of this ratio to predict PAR-associated cardiovascular mortality after TAVI, retrospectively analyzing data from 167 consecutive TAVI patients. PAR was graded angiographically, and the myocardial supply-demand ratio was estimated from the planimetric integration of the diastolic and systolic pressure-time area (DPTI and SPTI), respectively. PAR was observed in 113 patients (67%) and angiographically graded as mild in 89 (78.8%), moderate in 21 (18.6%) or moderate to severe in 3 (2.7%) cases. The DPTI:SPTI ratio decreased with increasing Sellers grade of PAR (P Ͻ 0.001). A DPTI:SPTI of Յ0.7 predicted cardiovascular mortality (area under the curve ϭ 0.96). Cardiovascular mortality at 30 days and 1 yr was increased in patients with DPTI:SPTI Յ 0.7 over those with DPTI:SPTI Ͼ 0.7 (42 vs. 2% and 63 vs. 3%, respectively; P Ͻ 0.001). In conclusion, DPTI:SPTI provides an excellent cutoff value of Յ0.7 for the prediction of PAR-associated mortality. aortic regurgitation; aortic stenosis; transcatheter aortic valve implantation.THE INCIDENCE OF moderate and severe paravalvular aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) varies from 10 to 20% (4,5,17,(21)(22)(23)27), and moderate-to-severe PAR after TAVI is associated with increased in-hospital mortality and unfavorable long-term outcome (1,11,14,20). PAR severity during TAVI is usually graded qualitatively using angiography. Quantitative evaluation of PAR has been recently proposed by use of the aortic regurgitation (AR) index, which is calculated as the ratio of the gradient between diastolic aortic pressure (DAP) and left ventricular (LV) end-diastolic pressure (LVEDP) to systolic blood pressure (SBP) ϫ 100 or [(DAP-LVEDP)/SBP] ϫ 100 (20) or more simply by use of the pressure difference between DAP and LVEDP (⌬P DAP-LVEDP ) (14). A pathophysiological understanding of PAR and its consequences is a prerequisite for an effective treatment and the improvement of survival.Myocardial ischemia is traditionally viewed as an imbalance of myocardial oxygen supply over demand. Such supplydemand ratio can be estimated from the ratio of the diastolic over systolic pressure time integral (DPTI:SPTI), which sensitively reflects the propensity to myocardial ischemia, notably subendocardial ischemia (7,8). Aortic regurgitation is typically associated with a reduce...

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Section: Resultssupporting

confidence: 74%

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Patsalis

Konorza

Al–Rashid

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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“…We gave priority to the STS score if both scores were available as it has been demonstrated to be superior to Euroscore in predicting outcomes (16,17). STS predicted risk of mortality (PROM) (mean <8%) was used as a benchmark for inclusion on the basis of the SURTAVI definition of the intermediate risk categories.…”

Section: Study Characteristicsmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Arora

Misenheimer

Jones

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons.Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.

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“…3,17,33 While a specific scoring system for TAVR is awaited, an individualized clinical decision by the treating team of cardiologists and cardiac surgeons is recommended. 3,27,29,30,33 A number of independent risk factors associated with poor outcome after TAVR has been identified. In the PARTNER Trial, low body mass index, prior stroke, low mean gradient, creatinine level at baseline, prior vascular surgery or stent, and chronic obstructive pulmonary disease requiring oxygen were shown to be predictors of mortality.…”

Section: Patient Selection For Tavrmentioning

confidence: 99%

“…38,39 As vascular injury is one of the most frequent complications of TAVR, occurring in approximately 10% of patients, 40 a thorough imaging of the arterial vasculature is essential before choosing the most suitable access route. 30 A basic assessment can be done by conventional angiography -for example, at the time of coronary angiography. However, more detailed information on luminal diameter, atherosclerosis, and vessel tortuosity can be gained by multidetector computed tomography (MDCT).…”

Section: Imaging Assessmentmentioning

confidence: 99%

“…STS score and EuroSCORE II seem to be more accurate predictors of mortality but are still insufficient to adequately identify patients for TAVR. [27][28][29][30][31][32][33] A particular disadvantage of all these scoring systems is that conditions such as porcelain aorta, liver cirrhosis, pulmonary hypertension, severe chronic obstructive pulmonary disease, patent coronary bypass grafts, chest radiation, and frailty are not fully taken into consideration. 3,17,33 While a specific scoring system for TAVR is awaited, an individualized clinical decision by the treating team of cardiologists and cardiac surgeons is recommended.…”

Section: Patient Selection For Tavrmentioning

confidence: 99%

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Transcatheter aortic valve replacement

Damberg¹,

Benstoem²,

Autschbach³

et al. 2013

RRCC

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Abstract:The standard treatment for symptomatic severe aortic valve stenosis is surgical aortic valve replacement. Over the last decade, transcatheter aortic valve replacement has emerged as an option for patients judged inoperable. It might also constitute an alternative for high-risk patients, even though which patients might benefit from this approach is still being discussed and remains controversial. Transcatheter heart valve replacement is a rapidly spreading technology. However, a number of problems still need to be addressed, such as paravalvular regurgitation, stroke rate, and postoperative conduction disturbances. Further, the durability of transcatheter heart valves remains unclear. Randomized clinical trials and long-term follow-up will help define the role of transcatheter heart valve replacement in aortic stenosis therapy.

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Relationship between the logistic EuroSCORE and the Society of Thoracic Surgeons Predicted Risk of Mortality score in patients implanted with the CoreValve ReValving System—A Bern-Rotterdam Study

Cited by 151 publications

References 22 publications

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Hemodynamic assessment of paravalvular aortic regurgitation after TAVI: estimated myocardial supply-demand ratio and cardiovascular mortality

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Transcatheter aortic valve replacement

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