Predicting mortality in high-risk TAVI patient: Is the EuroSCORE II superior to logistic EuroSCORE?

Objective: The assessment of perioperative risk is crucial for the decision whether patients preferably undergo open-heart aortic valve replacement or transcatheter aortic valve implantation.

Currently used risk scores (STS-Score and EurosSCORE) fail to predict perioperative risk and mortality in TAVI patients sufficiently.

This retrospective study aimed for evaluating the predictive value of the Euroscore II in comparison to established logistic Euroscore and STS-Score.

Methods: Between April 2007 and August 2012, 82 concomitant patients (50% male, 80 ± 7 years) underwent TAVI for severe symptomatic aortic stenosis. The STS and the logistic EuroSCORE was calculated routinely for risk assessment. Since November 2011 the EuroSCORE II was implemented additionally. Retrospectively, the EuroSCORE II was calculated in those patients who underwent TAVI procedure from April 2007 to November 2011. The estimated perioperative mortality by EuroSCORE II was compared to the established risk scores logistic Euroscore and STS Score.

Results: The calculated perioperative mortality was 16 ± 14% by Euroscore II, 35 ± 20% by logistic Euroscore and 9 ± 6% by STS Score. The observed 30-day mortality rate was 7% and 1 year survival 84%. 6% patients died due to cardiac related (cardiac decompensation), 4% unknown reason and 4% due to non-cardiac reasons (respiratory insufficiency, refusing of transfusions-Jehovah whiteness, multi organ failure, tumor progression, acute kidney injury, cerebral bleeding) within 1 year.

Conclusion: In our patients population the STS-Score is superior to the Euroscore II in predicting 30-day mortality. Predicted mortality by Euroscore II corresponds to the 1 year survival. Logistic EuroSCORE definitely overestimates the perioperative risk. For more suitable risk prediction in TAVI patients, a TAVI risk-score should be established.