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Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation.

Abstract : BACKGROUND: Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure. AIMS: To identify predictors of 6-month poor clinical outcomes after TAVI. METHODS: Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes. RESULTS: We included 163 patients (mean age, 79.9 ± 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 ± 11.4%). The primary endpoint occurred in 49 patients (mean age, 83 ± 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure ≥60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation ≥2/4 (OR 0.07) demonstrated a protective effect. CONCLUSION: Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection.
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Submitted on : Monday, January 6, 2014 - 11:28:36 AM
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Vincent Auffret, Dominique Boulmier, Emmanuel Oger, Marc Bedossa, Erwan Donal, et al.. Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation.. Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2014, 107 (1), pp.10-20. ⟨10.1016/j.acvd.2013.10.005⟩. ⟨inserm-00924055⟩

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