Performance of surgical risk scores to predict mortality after transcatheter aortic valve implantation

Rockwood Clinical Frailty Scale as a predictor of adverse outcomes among older adults undergoing aortic valve replacement: a protocol for a systematic review

INTRODUCTION

Frailty is associated with adverse outcomes relating to cardiac procedures. It has been proposed that frailty scoring should be included in the preoperative assessment of patients undergoing aortic valve replacement. We aim to examine the Rockwood Clinical Frailty Scale (CFS), as a predictor of adverse outcomes following aortic valve replacement.

METHODS AND ANALYSIS

Prospective and retrospective cohort studies and randomised controlled trials assessing both the preoperative frailty status (as per the CFS) and incidence of adverse outcomes among older adults undergoing either surgical aortic valve replacement or transcatheter aortic valve replacement will be included. Adverse outcomes will include mortality and periprocedural complications, as well as a composite of 30-day complications. A search will be conducted from 2005 to present using a prespecified search strategy. Studies will be screened for inclusion by two reviewers, with methodological quality assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Relative risk ratios with 95% CIs will be generated for each outcome of interest, comparing frail with non-frail groups. Data will be plotted on forest plots where applicable. The quality of the evidence will be determined using the Grading of Recommendations, Assessment, Development and Evaluation tool.

ETHICS AND DISSEMINATION

Ethical approval is not required for this study as no primary data will be collected. We will publish the review in a peer-reviewed journal on completion.

PROSPERO REGISTRATION NUMBER

CRD42020213757.

Ventilatory Efficacy After Transcatheter Aortic Valve Replacement Predicts Mortality and Heart Failure Events in Elderly Patients

BACKGROUND

We aimed to clarify the predictors of death or heart failure (HF) in elderly patients who undergo transcatheter aortic valve replacement (TAVR).Methods and Results:We prospectively enrolled 83 patients (age, 83±5 years) who underwent transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET) with impedance cardiography post-TAVR. We investigated the association of TTE and CPET parameters with death and the combined outcome of death and HF hospitalization. Over a follow-up of 19±9 months, peak oxygen uptake (V̇O₂) was not associated with death or the combined outcome. The minimum ratio of minute ventilation (V̇E) to carbon dioxide production (V̇CO₂) and the V̇E vs. V̇CO₂slope were higher in patients with the combined outcome. After adjusting for age, sex, Society of Thoracic Surgeons score and peak V̇O₂, ventilatory efficacy parameters remained independent predictors of the combined outcome (minimum V̇E/V̇O₂: hazard ratio, 1.108; 95% confidence interval, 1.010-1.215; P=0.031; V̇E vs. V̇CO₂slope: hazard ratio, 1.035; 95% confidence interval, 1.001-1.071; P=0.044), and had a greater area under the receiver-operating characteristic curve. The V̇E vs. V̇CO₂slope ≥34.6 was associated with higher rates of the combined outcome, as well as lower cardiac output at peak work rate during CPET.

CONCLUSIONS

In elderly patients, lower ventilatory efficacy post-TAVR is a predictor of death and HF hospitalization, reflecting lower cardiac output at peak exercise.

Prognostic value of lipid levels in short-term outcome after TAVI

BACKGROUND

A satisfactory risk score specific to transaortic valve implantation (TAVI) procedure is strongly needed for accurate assessment of postprocedural mortality and outcome. The purpose of this study was to investigate the association between certain clinical and laboratory parameters, particularly serum cholesterol levels, and major adverse cardiac events in patients who underwent TAVI.

METHOD

We retrospectively analyzed 119 patients who underwent TAVI at our institution between 2008 and 2016. The independent relationship between clinical and laboratory parameters and major adverse cardiac and cerebrovascular events (MACCE) was analyzed by regression analysis.

RESULTS

In all, 34 patients (28%) experienced MACCE during hospitalization and within 30 days of the procedure. Low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in the MACCE(+) group compared with the MACCE(-) group (91.9 ± 38 vs. 110.8 ± 38.1 mg/dl, p = 0.01; 33.7 ± 7.3 vs. 38.1 ± 9.8 mg/dl, p = 0.02, respectively). In multivariate logistic regression analysis, age, white blood cell count (WBC), and lower levels of LDL-C and HDL-C were found to be independently correlated with MACCE in the study population. Receiver operating curve (ROC) analysis revealed that an LDL value higher than 71 mg/dl predicted MACCE with a sensitivity of 45.4% and a specificity of 91.8% (AUC: 0.814; p = 0.02).

CONCLUSION

This study suggests that lower serum LDL-C and HDL-C levels are independently associated with short-term MACCE in post-TAVI patients. Lower levels of LDL and HDL cholesterol may indicate a poor prognosis. Measurement of serum lipid levels might improve the preoperative risk assessment of potential TAVI candidates.