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Open Heart. 2019 Apr 23;6(1):e000936. doi: 10.1136/openhrt-2018-000936. eCollection 2019.

Predictors of early mortality after transcatheter aortic valve implantation.

Author information

1
Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
2
Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
3
Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
4
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
5
Department of Cardiology, University Hospital of North Norway, Harstad, Norway.
6
Department of Anaesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
7
Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
8
Institute of Clinical Medicine, The Arctic University of Norway, UiT, Tromsø, Norway.
9
Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University og Science and Technology, NTNU, Trondheim, Norway.
10
Department of Cardiology, Saint Olavs University Hospital, Trondheim, Norway.
11
Department of Cardiothoracic and Vascular Surgery, Universitetssykehuset Nord-Norge, Tromso, Norway.

Abstract

Objectives:

To investigate whether preoperative echocardiographic evaluation of ventricular function, especially right ventricular systolic and diastolic parameters including speckle-tracking analysis, could aid in the prediction of 30-day mortality after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.

Methods:

This is a prospective observational cohort study including 227 patients accepted for TAVI at the University Hospital of North Norway and Oslo University Hospital from February 2010 through June 2013. All patients underwent preoperative transthoracic echocardiography with retrospective speckle-tracking analysis. Primary endpoint was all-cause 30-day mortality.

Results:

All-cause 30-day mortality was 8.7 % (n = 19). Independent predictors of 30-day mortality were systolic pulmonary arterial pressure (SPAP) > 60 mm Hg (HR: 7.7, 95% CI: 1.90 to 31.3), heart failure (HR: 2.9, 95% CI: 1.1 to 7.78), transapical access (HR: 3.8, 95% CI: 1.3 to 11.2), peripheral artery disease (HR: 6.0, 95% CI: 2.0 to 18.0) and body mass index (HR: 0.73, 95% CI: 0.61 to 0.87). C-statistic for the model generated was 0.91 (95% CI: 0.85 to 0.98). Besides elevated SPAP, no other echocardiographic measurements were found to be an independent predictor of early mortality.

Conclusion:

Except for elevated systolic pulmonary artery pressure, our data suggests that clinical rather than echocardiographic parameters are useful predictors of 30-day mortality after TAVI.

KEYWORDS:

TAVI; echocardiography; epidemiology; quality and outcome

Conflict of interest statement

Competing interests: Rolf Busund is a consultant for Edwards Lifesciences and has received speakers fee from Abbott. Lars Aaberge is a proctor for Edwards Lifesciences.

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