Background Transcatheter aortic valve implantation (TAVI) is associated with periprocedural and postprocedural morbidity and mortality. Currently, there is a paucity of risk stratification models for potential TAVI candidates. We employed the CHA₂DS₂-Vasc score to quantify the risk of 30-day mortality and morbidity in patients undergoing TAVI.

Methods and results A retrospective analysis of registry data for consecutive patients undergoing TAVI at 3 tertiary centres in Northwest England between 2008 and 2013. The CHA₂DS₂-Vasc score and its modification—the R₂CHA₂DS₂-Vasc score, which includes pre-existing renal impairment and pre-existing conduction abnormality (right bundle branch block/left bundle branch block, RBBB/LBBB)—were calculated for all patients. A total of 313 patients with a mean age of 80 (79.1–80.8) years underwent TAVI. The implanted devices were either the CoreValve or the Edwards-SAPIEN prosthesis. The 30-day mortality was 14.3% in those with a CHA₂DS₂-Vasc score ≥6, whereas it was only 6.2% in those with a score <6 (p=0.04). Using the R₂-CHA₂DS₂-Vasc score, the difference was more pronounced with a 30-day mortality of 22.6% in those patients with an R₂-CHA₂DS₂-Vasc score ≥7 compared to 6.0% in those with a R₂-CHA₂DS₂-Vasc score <7 (p=0.001). In multivariable Cox regression analyses, there was a significant and independent relationship between the CHA₂DS₂-Vasc score (hazard ratio (HR)= 2.71, (1.01 to 7.31); p<0.05) and the modified R₂CHA₂DS₂-Vasc score (HR=4.27 (1.51 to 12.07); p=0.006) with 30-day mortality.

Conclusions Our study demonstrates the potential use of the CHA₂DS₂-Vasc or the R₂CHA₂DS₂-Vasc score to quantify the risk of mortality in patients undergoing TAVI. This could have significant implications in terms of clinical as well as patients’ decision-making.