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Valvular heart disease
Original research article
Predictors of early mortality after transcatheter aortic valve implantation
  1. Didrik Kjønås1,
  2. Gry Dahle2,
  3. Henrik Schirmer3,4,
  4. Siri Malm5,
  5. Jo Eidet6,
  6. Lars Aaberge7,
  7. Terje Steigen1,8,
  8. Svend Aakhus9,10,
  9. Rolf Busund8,11 and
  10. Assami Rösner1
  1. 1Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
  2. 2Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
  3. 3Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
  4. 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  5. 5Department of Cardiology, University Hospital of North Norway, Harstad, Norway
  6. 6Department of Anaesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  7. 7Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  8. 8Institute of Clinical Medicine, The Arctic University of Norway, UiT, Tromsø, Norway
  9. 9Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University og Science and Technology, NTNU, Trondheim, Norway
  10. 10Department of Cardiology, Saint Olavs University Hospital, Trondheim, Norway
  11. 11Department of Cardiothoracic and Vascular Surgery, Universitetssykehuset Nord-Norge, Tromso, Norway
  1. Correspondence to Dr Henrik Schirmer; henrik.schirmer{at}medisin.uio.no

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.

  • TAVI
  • epidemiology
  • echocardiography
  • quality and outcome

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/openhrt-2018-000936

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    Footnotes

    • Contributors AR, HS, RB and SA designed the protocol. AR, SA, GD, JE, SM, LA and RB collected the data. DK performed the data extraction and the offline calculations. DK did the statistical analysis and drafting of the first version of the manuscript in close cooperation with AR, HS, RB and SA. All authors contributed to the revision and all aspects of the final manuscript, and are guarantors of the study.

    • Funding DK received grant from the Regional Health Authorities of North Norway.

    • 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.

    • Patient consent for publication Obtained.

    • Ethics approval Regional Ethical Committees for Medical Research Ethics, North and South East Norway.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.