Research paperPredictive mortality estimation in older patients undergoing TAVI comparison of the logistic EuroSCORE, EuroSCORE II and STS-score

BackgroundOlder people with aortic valve stenosis are often denied surgical aortic valve replacement. Transcatheter aortic valve implantation (TAVI) is proven to be a less invasive alternative. At present, we rely on the judgment of the Heart Team and the calculation of surgical risk scores to select TAVI candidates. Our aim is to compare the predictive value for early (procedural) and late (2 year) mortality of these surgical risk scores in TAVI patients.Material and methodsA retrospective single center study including all patients who underwent TAVI. The Logistic EuroSCORE (LES), EuroSCORE II (ES II), and Society of Thoracic Surgeons (STS) score were calculated for each patient. Each score was divided into low-, medium- and high-risk according to their definition. The actual procedural and 2 year mortality was then compared to the predicted mortality.ResultsOne hundred and fifty-seven patients were included. LES, ES II and STS-score ranked respectively 20%, 38% and 27% as low risk, respectively 45%, 44%, 57% as medium risk and respectively 35%, 18% and 16% as high-risk. The median predicted procedural mortality of the LES, ES II and STS-score were 16.2%, 5.3% and 5.4%, respectively. The actual procedural mortality was 8.2%. Only the STS-score predicted the highest 2 year mortality in the high-risk group (53%, P = 0.001).ConclusionNone of the surgical risk scores provide predictive value to estimate procedural risk and 2 year mortality in TAVI patients. Therefore, the need for a specific TAVI risk score imposes itself.