Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation

Background. - Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure. Aims. To identify predictors of 6-month poor clinical outcomes after TAVI. Methods. Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes. Results. We included 163 patients (mean age, 79.9 +/- 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 +/- 11.44 The primary endpoint occurred in 49 patients (mean age, 83 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure >= 60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation >= 2/4 (OR 0.07) demonstrated a protective effect. Conclusion. Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation >= 2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection. (C) 2013 Elsevier Masson SAS. All rights reserved.