Update and, internal and temporal-validation of the FRANCE-2 and ACC-TAVI early-mortality prediction models for Transcatheter aortic Valve Implantation (TAVI) using data from the Netherlands heart registration (NHR)

Introduction This study compares the incidence of vascular complications and other major outcomes between patients undergoing transcatheter aortic valve implantation, with and without a standardized preoperative vascular surgeon consultation. Methods This retrospective study evaluated all patients scheduled for transcatheter aortic valve implantation during a five-year period at a Hellenic University Hospital. Two main periods were evaluated: Group A (early period (2014–2015), without a standardized preoperative vascular surgeon consultation) and Group B (late period (2016–2018), with a standardized preoperative vascular surgeon consultation). All vascular complications as well as other major outcomes (early death, stroke, myocardial infarction, and treatment) were recorded. Univariate and multivariate analyses were also conducted. Results Overall, 382 transcatheter aortic valve implantation procedures were conducted (Group A: n = 115; duration = 19 months; Group B: n = 267; duration = 41 months). Overall, 58 vascular complications were recorded (21 patients in Group A and 37 patients in Group B (18.3% versus 13.9%; P = 0.279)). However, vascular complications that necessitated a vascular surgeon’s interference were more frequent during the first period (13% versus 4.9%; P = 0.009). Among patients with a vascular complication, early mortality was higher during the first period (14.3% versus 0%; P = 0.034) although stroke and myocardial infarction rates were similar. Age >80 years (OR = 1.856 [1.134–3.452]; P = 0.03) and preoperative vascular surgeon consultation (OR = 0.345 [0.132–0.756]; P = 0.015) were the only independent predictors for vascular complications. Conclusions A standardized preoperative evaluation by a vascular surgeon may decrease the risk for vascular complications that necessitate a repair as well as early mortality among patients undergoing transcatheter aortic valve implantation procedures.

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Novel United Kingdom prognostic model for 30-day mortality following transcatheter aortic valve implantation

Heart ◽

10.1136/heartjnl-2017-312489 ◽

2017 ◽

Vol 104 (13) ◽

pp. 1109-1116 ◽

Cited By ~ 18

Author(s):

Glen P Martin ◽

Matthew Sperrin ◽

Peter F Ludman ◽

Mark A de Belder ◽

Simon R Redwood ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Prediction Models ◽

Model Updating ◽

Characteristic Curve ◽

Predictive Performance ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

The Uk ◽

Valve Implantation

ObjectiveExisting clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes.MethodsA two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013–2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance.ResultsBetween 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI −0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66.ConclusionThe UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.

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Postprocedural Troponin Elevation and Mortality After Transcatheter Aortic Valve Implantation

Journal of the American Heart Association ◽

10.1161/jaha.120.020739 ◽

2021 ◽

Author(s):

Matthias Schindler ◽

Florin Stöckli ◽

Rico Brütsch ◽

Philipp Jakob ◽

Erik Holy ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Myocardial Injury ◽

Troponin T ◽

Fold Increase ◽

Mortality Prediction ◽

Reference Limit ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Background This study sought to investigate the role of postprocedural troponin elevations in mortality prediction after transcatheter aortic valve implantation and to define the threshold at which clinically relevant postprocedure myocardial injury determines mortality. Methods and Results A total of 1333 consecutive patients with transcatheter aortic valve implantation with available postprocedural high‐sensitivity cardiac troponin T measurements were included in the analysis. The threshold at which postprocedure myocardial injury determines long‐term mortality was identified using restricted cubic spline analysis. A >18.3‐fold increase of troponin above the upper reference limit was identified as threshold for relevant postprocedure myocardial injury. Associations remained significant in a landmark analysis between 30 days and 2 years (hazard ratio [HR], 1.61, [95% CI, 1.13–2.28]; P =0.01), after adjusting for known confounders (adjusted HR, 1.90 [95% CI, 1.40–2.57]; P <0001), and in subgroups of patients with coronary artery disease (adjusted HR, 2.17 [95% CI, 1.44–3.29]; P <0.001), renal dysfunction (adjusted HR, 1.88 [95% CI, 1.35–2.62]; P <0.001), and intermediate/high surgical risk (adjusted HR, 2.70 [95% CI, 1.40–5.22]; P =0.003). Conclusions This study determined a troponin threshold for the identification of patients at increased mortality risk after transcatheter aortic valve implantation. The proposed definition of postprocedure myocardial injury advances risk stratification in patients with transcatheter aortic valve implantation and may assist in postprocedural patient management.

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