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. 2019 Apr 23;6(1):e000936.
doi: 10.1136/openhrt-2018-000936. eCollection 2019.

Predictors of early mortality after transcatheter aortic valve implantation

Didrik Kjønås  1 , Gry Dahle  2 , Henrik Schirmer  3   4 , Siri Malm  5 , Jo Eidet  6 , Lars Aaberge  7 , Terje Steigen  1   8 , Svend Aakhus  9   10 , Rolf Busund  8   11 , Assami Rösner  1
Affiliations

Predictors of early mortality after transcatheter aortic valve implantation

Didrik Kjønås et al. Open Heart. .

Abstract

Objectives: To investigate whether preoperative echocardiographic evaluation of ventricular function, especially right ventricular systolic and diastolic parameters including speckle-tracking analysis, could aid in the prediction of 30-day mortality after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.

Methods: This is a prospective observational cohort study including 227 patients accepted for TAVI at the University Hospital of North Norway and Oslo University Hospital from February 2010 through June 2013. All patients underwent preoperative transthoracic echocardiography with retrospective speckle-tracking analysis. Primary endpoint was all-cause 30-day mortality.

Results: All-cause 30-day mortality was 8.7 % (n = 19). Independent predictors of 30-day mortality were systolic pulmonary arterial pressure (SPAP) > 60 mm Hg (HR: 7.7, 95% CI: 1.90 to 31.3), heart failure (HR: 2.9, 95% CI: 1.1 to 7.78), transapical access (HR: 3.8, 95% CI: 1.3 to 11.2), peripheral artery disease (HR: 6.0, 95% CI: 2.0 to 18.0) and body mass index (HR: 0.73, 95% CI: 0.61 to 0.87). C-statistic for the model generated was 0.91 (95% CI: 0.85 to 0.98). Besides elevated SPAP, no other echocardiographic measurements were found to be an independent predictor of early mortality.

Conclusion: Except for elevated systolic pulmonary artery pressure, our data suggests that clinical rather than echocardiographic parameters are useful predictors of 30-day mortality after TAVI.

Keywords: TAVI; echocardiography; epidemiology; quality and outcome.

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Conflict of interest statement

Competing interests: Rolf Busund is a consultant for Edwards Lifesciences and has received speakers fee from Abbott. Lars Aaberge is a proctor for Edwards Lifesciences.

Figures

Figure 1
Figure 1
Example of how the RV strain curves are generated from a two-dimensional four-chamber view. RV, right ventricular.
Figure 2
Figure 2
Kaplan-Meier curves for each independent predictor stratified according to 30-day all-cause mortality. Heart failure defined as clinical signs of heart failure in the form of unusual dyspnoea on light exertion, orthopnoea, fluid retention, rales on auscultation, or pulmonary oedema on chest X-ray less than 2 weeks prior to TAVI. BMI, body mass index; eGFR, estimated glomerular filtration rate; PAD, peripheral artery disease; SPAP, systolic pulmonary arterial pressure; TAVI, transcatheter aortic valve implantation,
See this image and copyright information in PMC

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