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TAVR possible in patients at low, intermediate STS risk
Transcatheter aortic valve replacement is possible in Society of Thoracic Surgeons–defined low- or medium-risk patients when guided by the decision of an interdisciplinary heart team, prospective study results showed.
To assess clinical outcomes among patients with estimated low or intermediate surgical risk, researchers categorized 389 consecutive patients who underwent TAVR between August 2007 and October 2011 by the Society of Thoracic Surgeons (STS) score into low- (<3%; n=41, 10.5%), intermediate- (≥3% and ≤8%; n=254, 65.3%) and high-risk (>8%; n=94, 24.2%) groups.
There were significant differences between the groups for age (low risk, 78.2 ± 6.7 years; intermediate risk, 82.7 ± 5.7 years; high risk, 83.7 ± 4.9; P<.001), BMI (low risk, 28.1 ± 6.1; intermediate risk, 26.5 ± 4.9; high risk, 24.4 ± 4.6; P<.001), chronic renal failure (low risk, 34%; intermediate risk, 67%; high risk, 90%; P<.001), all-cause mortality at 30 days (low risk, 2.4%; intermediate risk; 3.9%; high risk, 14.9%; P=.001) and all-cause mortality at 1 year (low risk, 10.1%; intermediate risk, 16.1%; high risk, 34.5%; P=.0003).
There were no differences in cerebrovascular accidents and MI during 1-year follow-up, whereas all-cause mortality was highest among high-risk patients, followed by intermediate- and low-risk patients (low risk, 34.5%; intermediate risk, 16.1%; high risk, 10.1%; P=.0003).
Researchers noted that all patients were considered to be at increased surgical risk, but applying the STS score calculated an estimated intermediate risk.
“Significant comorbidities and high-risk features that are not accounted for in the STS risk and EuroSCORE contribute to this difference,” they wrote. “This suggests that patient selection based on risk score calculation only is not sufficient to assess the ‘true’ risk of a patient undergoing [surgical aortic valve replacement]. Thus, careful patient selection based on the Heart Team model is required for appropriate treatment allocation.”
Disclosure: Wenaweser reports being a proctor and receiving honoraria from Edwards Lifesciences and Medtronic.