Abstract 12281: Outcomes in Patients Treated With Transfemoral Aortic Valve Implantation After Admission to the Intensive Care Unit
Introduction: Transcatheter aortic valve implantation (TAVI) has become established as a treatment option for patients with severe symptomatic aortic valve stenosis. Postoperative treatment of these old patients presents a new challenge for intensive care specialists. Although numerous studies have addressed perioperative anesthetic management, little is known about risk factors that lead to a longer intensive care unit (ICU) stay.
Hypothesis: We retrospectively analyzed data focusing on the risk factors and indications for a prolonged ICU stay and their outcomes. We also compared predictive value of the SAPS II and EuroSCORE risk evaluation scales.
Methods: From 2006 to 2012 a total of 214 consecutive patients (age: 80 ± 6 years) were admitted to the ICU after transfemoral TAVI.
Results: Total 30-day mortality was 7%. Non-survivors differed from survivors in the rates of catecholamine therapy on ICU admission (93 vs. 29%; p<0.001), stroke (20 vs. 1%; p<0.001), and sepsis (27 vs. 2%; p<0.001). Acute kidney injury (83 vs. 56%; p < 0.001) and catecholamine therapy (88 vs. 61%; p < 0.001) significantly influenced 2-year survival. Mean SAPS II score was higher in non-survivors (38.1 ± 7.0 vs. 29.9 ± 6.2; p < 0.001), giving a predicted mortality of 23.1 ± 11.7% and 10.5 ± 8.2%, respectively, whereas the logistic EuroSCORE was not able to discriminate between the groups (p = 0.555) (figure 1). Among the biochemical parameters, the maximum values of creatinine (2.46±1.24 vs. 1.77±1.16 mg/dL; p <0.05), procalcitonin (1.44 ± 1.84 vs. 0.51 ± 1.65 ng/mL; p < 0.05), and troponin I (4.46 ± 4.19 vs. 2.02 ± 2.25 ng/mL; p < 0.001) during ICU admission were significantly higher in non-survivors.
Conclusions: The SAPS II score was superior to the EuroSCORE in predicting ICU mortality and could be used for post-interventional risk stratification while distinct TAVI risk scores are lacking. Creatinine, procalcitonin, and troponin are strong predictors of 30-day and 2-year mortality after TAVI.
Author Disclosures: F. Al-Rashid: None. P. Kahlert: None. H. Hildebrandt: None. F. Selge: None. P. Patsalis: None. D. Wendt: None. M. Thielmann: None. H. Jakob: None. G. Heusch: None. R. Erbel: None. R. Janosi: None.
- © 2015 by American Heart Association, Inc.