Risk assesment in TAVI including valve-in-valve
Comparison of new EuroSCORE II with logistic EuroSCORE and STS score in predicting 30-day and one-year mortality in patients undergoing TAVI
Aims: The validity of the logistic EuroSCORE (LES) and STS score for risk stratification in patients undergoing TAVI is questionable. The purpose of this study was to compare the newly created EuroSCORE II (ES II) with the LES and STS score in patients undergoing TAVI by Medtronic CoreValve or Edwards SAPIEN after formal turn-down for surgical AVR.
Methods and results: Eighty-two consecutive patients in a single institution underwent TAVI via the transfemoral, trans-subclavian, transapical and direct aortic approaches. Estimated LES, ES II and STS score were calculated retrospectively. The 30-day mortality was 7.3% (6/82) and the one-year mortality was 23.2% (19/82). The mean LES of patients who did not survive at 30 days was 33% and among survivors it was 23.5% (p=0.8; RR 1.4, 95% CI 0.44-4.46). The ES II at 30 days was 20.1% in non-survivors and 10.3% in survivors (p=0.62, RR 1.96, 95% CI 0.61 - 6.32). The STS score was 9.1% and 7.6% (p=0.87; RR 1.2, 95% CI 0.5-2.89) in non-survivors and survivors respectively. At one-year, the mean LES in non-survivors was 28.2% and 22.9% in survivors (p=0.84; RR 1.23, 95% CI 0.51-3.0). ES II was 13.9% and 10.2% (p=0.79; RR 1.36, 95% CI 0.5-3.71). The STS score was 8% and 7.6% (p=0.95; RR 1.05, 95% CI 0.52-2.14). Overall there was no difference in the relative risk between the non-survivors and survivors based on any of the three risk scores. We then classified the patients into low, intermediate and high risk groups (LES <10, 10-20, >20%, ES II <5, 5-10, >10% and STS <5, 5-10, >10% respectively) and analysed the 30-day and one-year mortality. Patients in the high ES II risk group (>10%) had higher mortality compared with both low-risk and intermediate-risk groups at 30 days and one year following TAVI, although this failed to reach statistical significance. In contrast the LES and STS score did not show any consistent trends among the three risk groups.
Conclusions: ES II was no better than LES or STS score in predicting 30-day or one-year mortality in patients undergoing TAVI after formal surgical turn-down. ES II may predict mortality better in the highest risk group. This study highlights the deficiencies of all three surgical risk scores in predicting mortality in patients undergoing TAVI and thus the need to develop a dedicated TAVI risk score system.
