Risk assesment in TAVI including valve-in-valve
Comparison of EuroSCORE and EuroSCORE II in predicting short-term mortality in patients undergoing TAVI
Aims: The logistic EuroSCORE was designed to estimate the risk of 30-day mortality in surgical patients, especially those undergoing coronary artery bypass grafting. However, when applied to isolated surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI), it is believed to overestimate the real risk. We sought to determine whether the newly proposed EuroSCORE II scale is better calibrated with absolute risk of mortality in an unselected cohort of patients treated with TAVI.
Methods and results: The EuroSCORE and EuroSCORE II were assessed in 49 high-risk patient with aortic valve stenosis treated with TAVI from March 2010 to February 2012. The majority of cases were performed via the transfemoral route (n=36, 74%) followed by the left transsubclavian (n=8, 16%), transapical (n=3, 6%) and transaortic access (n=2, 4%). Mortality was assessed at 30 days. The study population consisted of 23 females (47%) and 26 males (53%). The mean age was 79.9±6.2 years. The expected mortality according to the EuroSCORE was 17.5% (95% confidence intervals [CI] 14.3%-20.7%), whereas in EuroSCORE II it was 5.9% (95% CI 4.2%-7.6%). After a 30-day follow-up, the observed mortality was 4.1% (two out of 49). The patients who died were only characterised by low-to-medium mortality risk in both scales (11.6% and 13.6% by EuroSCORE, 3.5% and 4.4% by EuroSCORE II).
Conclusions: EuroSCORE II more accurately predicts mean mortality in patients after TAVI. However, both current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient treated with TAVI.
