Abstract 4377: Euroscore and STS PROM are Not Accurate in Predicting Operative Mortality in Patients Undergoing Transapical Aortic Valve Implantation
Objectives: Patient selection for transapical aortic valve implantation (TA-TAVI) is subject of debate. Risk assessment for patients is currently performed with the EuroSCORE and STS-PROM algorithms. None of these scores were designed for such a population. Both scores were compared to the real outcome in patients undergoing TA-TAVI.
Methods: Thirty six patients underwent TA-TAVI using the Edwards Sapien bioprosthesis between September 2007, and June 2009 due to contraindications of conventional surgery and/or high operative risk. Mean age was 81±9.8 Years, and 40% were female. Patient comorbidities included chronic lung disease (22,2%), renal failure (33,3%), neurological dysfunction (11,1%), peripheral arteriopathy (66.7%), previous cardiac surgery (41,6%), diabetes (27,7%), severe pulmonary hypertension ≥60 mmHg (16,7%), moderate LV dysfunction EF≤50% (50,05%) and LVEF ≤30% (19,4%) which were accounted for in these scores. Other comorbidities as porcelain aorta (36,1 %), cancer (25%) and mediastinal irradiation (5,5%) did not figure in the algorithms. Mean STS and EuroSCORE were 22.3% (±2.1) and 30.9% (±2.2), respectively. The actual and predicted mortality were compared.
Results: Operative mortality (30 days) was 5 patients (15.6 %). An additional 5 patients (15.6 %) died during the follow-up study period of 587days (mean 324±164). Both the STS and EuroSCORE failed to demonstrate significant correlation with predicted operative mortality (HR=0.97, [95%CI 0.98 –1.06] p=0.536 and HR=0.99, [95%CI 0.90 –1.08] p=0.818, respectively).
Conclusion: Current surgical scores are poor algorithms in predicting operative mortality in patients undergoing TA-TAVI and correlate poorly with the observed outcome. Refining these scores or developing specific algorithms for high risk patients with severe symptomatic aortic stenosis is necessary to improve patient selection for TA-TAVI.