The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase

Hemmann, Katrin; Sirotina, Margarita; Rosa, Salvatore De; Ehrlich, Joachim R.; Fox, Henrik; Weber, Johannes; Moritz, Anton; Zeiher, Andreas M.; Hofmann, Ilona; Schächinger, Volker; Doss, Mirko; Sievert, Horst; Fichtlscherer, Stephan; Lehmann, Ralf

doi:10.1093/icvts/ivt132

Cited by 78 publications

(50 citation statements)

References 21 publications

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“…23 A recent report from another European registry demonstrated that early hazard of death was higher after TA-TAVR than TF-TAVR, but the long-term prognosis was equivalent. 24 As experience with patient selection and performing TA-TAVR grew, early mortality and complications diminished. 21 Whether further improvement is achievable with other anatomic approaches such as direct transaortic is unknown.…”

Section: Differences In Outcomementioning

confidence: 99%

Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement

et al. 2015

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Background— The higher risk of adverse outcomes after transapical (TA) versus transfemoral (TF) transcatheter aortic valve replacement (TAVR) could be attributable to TA-TAVR being an open surgical procedure or to clinical differences between TA- and TF-TAVR patients. We compared outcomes after neutralizing patient differences using propensity score matching. Methods and Results— From April 2007 to February 2012, 1100 Placement of Aortic Transcatheter Valves (PARTNER)-I patients underwent TA-TAVR and 1521 underwent TF-TAVR with Edwards SAPIEN balloon-expandable bioprostheses. Propensity matching based on 111 preprocedural variables, exclusive of femoral access morphology, identified 501 well-matched patient pairs (46% of possible matches), 95% of whom had peripheral arterial disease. Matched TA-TAVR patients experienced more adverse procedural events, longer length of stay (5 versus 8 days; P <0.0001), and slower recovery (New York Heart Association class I, 31% versus 38% at 30 days, equalizing by 6 months at 51% versus 47%); stroke risk was similar (3.4% versus 3.3% at 30 days and 6.0% versus 6.7% at 3 years); mortality was elevated for the first 6 postprocedural months (19% versus 12%; P =0.01); but aortic regurgitation was less (34% versus 52% mild and 8.9% versus 12% moderate to severe at discharge, P =0.001; 36% versus 50% mild and 10% versus 15% moderate to severe at 6 months, P <0.0001). Conclusions— The likelihood of adverse periprocedural events and prolonged recovery is greater after TA-TAVR than TF-TAVR in vasculopathic patients after accounting for differences in cardiovascular risk factors, although stroke risk is equivalent and aortic regurgitation is less. As smaller delivery systems permit TF-TAVR in many of these patients, we recommend a TF-first access strategy for TAVR when anatomically feasible. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00530894.

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Section: Differences In Outcomementioning

confidence: 99%

Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement

et al. 2015

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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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“…While Stahli et al 16 in a cohort of 350 patients and Sedaghat et al 15 in a cohort of 206 patients demonstrated the superiority of EuroSCORE II, Hemmann et al 17 in a record of 426 patients considered the STS superior. Other studies, as well as our work, demonstrated no difference between the scores, and, in our case, both the EuroSCORE II and STS scores had the ability to predict mortality, with AUC of 0.77 and 0.81, respectively.…”

Section: Discussionmentioning

confidence: 99%

EuroSCORE II and STS as mortality predictors in patients undergoing TAVI

Rosa¹,

Lopes²,

Accorsi³

et al. 2016

Rev. Assoc. Med. Bras.

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SUMMARY Introduction: the EuroSCORE II and STS are the most used scores for surgical risk stratification and indication of transcatheter aortic valve implantation (TAVI). However, its role as a tool for mortality prediction in patients undergoing TAVI is still unclear. Objective: to evaluate the performance of the EuroSCORE II and STS as predictors of in-hospital and 30-day mortality in patients undergoing TAVI. Methods: we included 59 symptomatic patients with severe aortic stenosis that underwent TAVI between 2010 and 2014. The variables were analyzed using Student's t-test and Fisher's exact test and the discriminative power was evaluated using receiver operating characteristic curve (ROC) and area under the curve (AUC) with a 95% confidence interval. Results: mean age was 81±7.3 years, 42.3% men. The mean EuroSCORE II was 7.6±7.3 % and STS was 20.7±10.3%. Transfemoral procedure was performed in 88.13%, transapical in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and 30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS higher than the survivors (33.7±16.7vs. 18.6±7.3% p=0,0001 for STS and 13.9±16.1 vs. 4.8±3.8% p=0.0007 for EuroSCORE II). The STS showed an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences in the discrimination ability using ROC curves (p=0.72). Conclusion: in this cohort, the STS and EuroSCORE II were predictors of in-hospital and 30-days mortality in patients with severe aortic stenosis undergoing TAVI.

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The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase

Abstract: The STS score outperforms the logistic EuroSCORE in predicting adverse outcomes following TAVI. The transapical approach is associated with higher perioperative mortality, but does not exert any influence on long-term prognosis beyond the periprocedural phase.

Cited by 78 publications

References 21 publications

Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement

Propensity-Matched Comparisons of Clinical Outcomes After Transapical or Transfemoral Transcatheter Aortic Valve Replacement

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

EuroSCORE II and STS as mortality predictors in patients undergoing TAVI

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