Real World Analysis of the Effect of Surgical Risk Profile on Clinical Outcomes after Transcatheter Aortic Valve Replacement
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Udit Bhaskar Bhatnagar, M.D.
,
University of South Dakota Sanford School of Medicine, Sioux Falls, SD
Maheedhar Gedela, M.D.
,
Sanford Cardiovascular Institute, Sioux Falls, SD
Chirag K Desai, M.D.
,
Sanford USD Medical Center, Soux Falls, SD
Terezia Petraskova, BA
,
Sanford Cardiovascular Institute, Sioux Falls, SD
Valerie Bares, PhD
,
Sanford USD Medical Center, Soux Falls, SD
Adam T. Stys, M.D., FSCAI
,
Sanford Cardiovascular Institute, Sioux Falls, SD
Tomasz Stys, M.D., FSCAI
,
Sanford Cardiovascular Institute, Sioux Falls, SD
Background:
Recent trials have documented the superiority of Transcatheter Aortic Valve Replacement (TAVR) over surgical replacement in patients with intermediate to high surgical risk. This study seeks to compare the procedural and clinical outcomes of TAVR among different surgical risk profiles, as measured by Society of Thoracic Surgery (STS) score.
Methods:
Patients undergoing TAVR at our institute from Sep 2012 to Feb 2017 were compared among low (STS <4), intermediate (STS 4-8) and high (STS >8) risk groups. Readmissions and adverse events were studied as early (≤30 day) and late (>30 day) events.
Results:
TAVR was performed in 178 patients during the study period (mean age - 81.22 ± 8.21 years). Mean STS score was 8.54 ± 5.37. Patients with higher STS scores were, by definition, older and had higher comorbidities. (Table 1) Procedural efficacy was similar among the three groups in terms of total procedure and fluoroscopy time. (Table 2) Higher STS risk scores were correlated with longer length of stay (2.27±1.59 vs 4.47±4.22 days in low vs high risk group. Pearson Correlation coefficient– 0.16, P=0.03). There seemed to be a trend towards increased in-hospital adverse events and early/late readmissions with higher STS scores, but this was not statistically significant.
Conclusions:
In this single center real world analysis higher surgical risk score was correlated with a longer length of stay. However STS score was not predictive of early (≤30 day) or late (>30 day) post-op adverse events or re-admissions after TAVR. There is a need for development of better risk prediction models specifically for TAVR, to aid in more informed decision making.
