330 Accuracy of surgical scores for prediction of operative mortality in patients undergoing transapical aortic valve implantation?

Abstract

Risk assessment for patients undergoing transapical aortic valve implantation (TAVI) is currently performed with the EuroSCORE and STS-PROM risk algorithms. None of these scores were designed for a TAVI population. To demonstrate their accuracy, both scores were compared to the real outcome in patients undergoing TAVI. 33 patients underwent TAVI using the Edwards Sapien bioprosthesis between September 2007, and April 2009 due to contraindications of conventional surgery and/or high operative risk. Mean age was 81 ± 9.8 Years, and 40% were female. Mean STS and EuroSCORE were 21% and 28.6%, respectively. Multiple variables were used in the calculation of the EuroScore and the STS-PROM algorithms including chronic lung disease (24%), renal Failure (36.4%), cancer (27.3%), neurological dysfunction (12%), peripheral arteriopathy (69.7%), previous cardiac surgery (42.4%), Diabetes (30%), severe pulmonary hypertension ≥ 60 mmHg (18.2%), moderate LV dysfunction EF≤50% (54.6%), and LVEF ≤ 30% (21.2%). Certain variables do not figure in the algorithm as porcelain aorta (39.4%) and mediastinal irradiation (6%). Observed in-hospital death was 18.2%. The actual and predicted mortality were compared. Operative mortality (30 days) = 5 patients (15.6%). An additional 4 patients (12.1%) died during the follow-up study period of 587days (mean 324 ± 164). Overall mortality = 9 patients (27.3%). Both the STS and EuroSCORE failed to demonstrate significant correlation with predicted operative mortality (p=0.145 and 0.875, respectively). The STS algorithm seems more accurate in estimating the operative mortality in TAVI patients. Current surgical scores correlate poorly with the observed outcome. Refining these scores for high risk patients requiring aortic valve surgery may improve patient selection for TAVI.