Early and late mortality in patients undergoing transcatheter aortic valve implantation: comparison of the novel EuroScore II with established risk scores.

OBJECTIVES: In the evaluation of patients considered for transcatheter aortic valve implantation (TAVI), the EuroScore II might be superior to established risk scores. METHODS: We assessed the performance of the EuroScore II in predicting mortality in a cohort of 350 TAVI patients. RESULTS: The EuroScore II and the logistic EuroScore were higher in nonsurvivors compared to survivors at 30 days (12.6 ± 1.8 vs. 7.5 ± 0.3%, p < 0.001 for EuroScore II, and 27.7 ± 2.8 vs. 22.1 ± 0.8%, p = 0.04 for logistic EuroScore), while the STS-PROM score did not differ (7.3 ± 0.8 vs. 6.4 ± 0.3%, p = 0.09). The area under the curve (AUC) was 0.70 for the EuroScore II, 0.61 for the logistic EuroScore and 0.59 for the STS-PROM score for predicting 30-day mortality. Based on the estimated 30-day mortality risk, 3 risk groups were identified, a low-risk (EuroScore II ≤4%, 30-day mortality 1.2%), an intermediate-risk (EuroScore II between 4% and 9%, 30-day mortality 8.6%) and a high-risk group (EuroScore II >9%, 30-day mortality, 17.1%; p = 0.03). Regarding cumulative mortality, the AUC was 0.67 for the EuroScore II, 0.62 for the logistic EuroScore and 0.55 for the STS-PROM score for predicting mortality at total follow-up. CONCLUSIONS: In this patient cohort, the EuroScore II performed best in predicting short- and long-term mortality.

Age- and gender-dependent left ventricular remodeling.

BACKGROUND: The effect of age and gender on left ventricular (LV) size, muscle mass, and systolic function as determined by two-dimensional echocardiography has not yet been investigated in a large population. METHODS: Normal transthoracic two-dimensional echocardiography studies of 5307 subjects (47% males) performed between March 1990 and December 2011 were analyzed. LV end-diastolic volume index (LVEDVI), LV muscle mass index (LVMMI), LV ejection fraction (LVEF), and LV fractional shortening (LVFS) were compared in different age groups. RESULTS: LVMMI increased in females from 66.4 ± 1.3 g/m(2) (7-20 years) to 76.3 ± 0.9 g/m(2) (60-80 years; P < 0.0001) and in males from 81.9 ± 1.7 g/m(2) (7-20 years) to 94.6 ± 1.3 g/m(2) (60-80 years; P < 0.0001). LVEDVI decreased in females from 49.8 ± 0.9 mL/m(2) (7-20 years) to 42.8 ± 0.6 mL/m(2) (60-80 years; P < 0.0001) and in males from 56.6 ± 0.8 mL/m(2) (7-20 years) to 49.0 ± 0.7 mL/m(2) (60-80 years; P < 0.0001). A significant increase in LVEF was observed with age (P < 0.0001 for both genders), but it was more pronounced in females (62 ± 0.5% [age 7-20 years] vs. 65 ± 0.3% [age 60-80 years]) than in males (62 ± 0.5% [age 7-20 years] vs. 64 ± 0.3% [age 60-80 years]). Similarly, LVFS increased in females from 37.7 ± 0.5% (7-20 years) to 42.4 ± 0.4% (60-80 years; P < 0.001) and in males from 37.3 ± 0.5% (7-20 years) to 39.4 ± 0.5% (60-80 years; P < 0.001). CONCLUSIONS: LVEF, LVFS, and LVMMI increase with advancing age, in particular in females. In contrast, LVEDVI decreases with age. These findings indicate that the LV undergoes a lifelong remodeling.

Transcatheter aortic valve-in-valve implantation: clinical outcome as defined by VARC-2 and postprocedural valve dysfunction according to the primary mode of bioprosthesis failure.

OBJECTIVES: The objectives of this study were to investigate: (1) the clinical outcome of transcatheter aortic valve-in-valve (VIV) implantation according to Valve Academic Research Consortium (VARC)-2 criteria; and (2) to determine whether postprocedural transvalvular gradients differ in patients with bioprosthesis regurgitation or stenosis as primary mode of failure. BACKGROUND: Transcatheter aortic VIV implantation has become a feasible option for selected high-risk patients with failed aortic surgical bioprostheses. METHODS: Transcatheter aortic VIV implantation was performed in 14 high-risk individuals at the University of Zurich and University College London. RESULTS: The prosthesis was successfully implanted in 13 patients (93%). In 1 patient, a second transcatheter valve needed to be implanted due to valve malpositioning. Thirty-day all-cause mortality was 7% (1/14). Prosthetic valve dysfunction according to VARC-2 at 30 days was observed in 7/14 patients (50%) due to an increased postprocedural transvalvular gradient >20 mm Hg. Preprocedural transaortic gradients correlated significantly with postprocedural gradients (r=0.91; P<.001). At 30-day follow-up, postprocedural gradients were higher in patients with aortic stenosis as primary mode of failure as compared to those with aortic regurgitation (36 ± 6 mm Hg vs 16 ± 4 mm Hg; P=.01). None of the patients exhibited prosthetic valve regurgitation of more than mild degree. CONCLUSION: The feasibility and safety of VIV implantation in failed aortic bioprostheses is demonstrated. A higher postprocedural gradient was observed after VIV implantation in patients with aortic stenosis as compared to regurgitation as primary mode of failure.