The impact of subclinical congestion on the outcome of patients undergoing transcatheter aortic valve implantation

Abstract

Background We investigated the impact of an elevated plasma volume status (PVS) in patients undergoing TAVI on early clinical safety and mortality and assessed the prognostic utility of PVS for outcome prediction. Materials and methods We retrospectively calculated the PVS in 652 patients undergoing TAVI between 2009 and 2018 at two centres. They were then categorized into two groups depending on their preoperative PVS (PVS ≤−4; n = 257 vs PVS>−4; n = 379). Relative PVS was derived by subtracting calculated ideal (iPVS = c × weight) from actual plasma volume (aPVS = (1 − haematocrit) × (a + (b × weight in kg)). Results The need for renal replacement therapy (1 (0.4%) vs 17 (4.5%); P = .001), re‐operation for noncardiac reasons (9 (3.5%) vs 32 (8.4%); P = .003), re‐operation for bleeding (9 (3.5%) vs 27 (7.1%); P = .037) and major bleeding (14 (5.4%) vs 37 (9.8%); P = .033) were significantly higher in patients with a PVS>−4. The composite 30‐day early safety endpoint (234 (91.1%) vs 314 (82.8%); P = .002) confirms that an increased preoperative PVS is associated with a worse overall outcome after TAVI. Conclusions An elevated PVS (>−4) as a marker for congestion is associated with significantly worse outcome after TAVI and therefore should be incorporated in preprocedural risk stratification.

Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

“…In a cohort of 652 TAVI patients, PVS ≥4 was associated with all-cause mortality in the longer term and was associated with a 30-day composite of all-cause mortality, stroke, life-threatening bleeding, acute kidney injury, coronary artery obstruction requiring intervention, major vascular complication and valve related dysfunction requiring repeat procedure. 22 However, PVS ≥4 was not associated with the primary endpoint for that study, 22 that is, 30-day mortality, and until now the findings have not undergone external validation in an independent cohort. Our study builds on previous data, by independently validating the association between elevated PVS and mortality, and showing that PVS >0% is associated with prolonged ICU stay.…”

Impact of plasma volume status on mortality following left ventricular assist device implantation

“…This accuracy was validated by comparing scintigraphy tests, 7,8 with prognostic implication on heart failure recurrence and mortality also demonstrated in prior published studies 7,8 . PV additionally has been shown to predict clinical risk in several clinical settings other than heart failure, including transcatheter aortic valve replacement and coronary artery bypass grafting registries 9,10 …”

“…Recently, a novel procedure to noninvasively estimate plasma volume (PV) simply using hematocrit (Ht) and body weight (BW), has been proposed 6 . This specific accuracy was validated using scintigraphy tests, 7,8 and its prognostic implication in heart failure cohorts was demonstrated in several clinical settings 9,10 …”

Impact of Subclinical Congestion on Outcome of Patients Undergoing Mitral Valve Surgery

“…In line with findings in the known literature, 32.1% of patients in our cohort presented in a preoperative state of (subclinical) decompensation represented by a PVS above the defined cut-off level similar to those presented in recent studies. [ 6 , 7 , 9 , 16 ].…”

“…Recent literature has demonstrated that plasma volume status (PVS) can be calculated easily based on the patients’ weight, gender and hematocrit [ 7 ]. Furthermore, an elevated PVS is known to directly correlate with increased mortality in patients with stable CHF, and has been applied for risk stratification in patients undergoing coronary artery bypass graft surgery or transcatheter aortic valve replacement [ 8 , 9 ].…”