Predictors of poor clinical improvement after transcatheter aortic valve implantation: To TAV or not to TAV

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become an appealing option in managing patients with severe aortic stenosis (AS) after demonstrating better survival rates, reduction in symptom burden, and improvement in the quality of life (QOL). However, some patients fail to demonstrate benefits after TAVI, whether in terms of survival or QOL.
Objective: This study opted to investigate the predictors of poor clinical outcomes following TAVI from a real-world national registry
Patients and Methods: This prospective observational study was derived from an Egyptian single-center registry through the duration from November 2022 to May 2023. It included 122 patients who were treated with TAVI. The participants’ QOL was evaluated using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire at baseline and 6 months follow-up after TAVI. Participants were subdivided into two groups: Group A (good improvement) reported survival and >20% improvement from baseline and group B (poor improvement) reported mortality or ≤ 20% improvement.
Results: The mean age of our patients was 73.67 ± 7.04 years, 47.5% were males. A total of 106 patients (86.9%) showed good outcomes in the form of survival and QOL improvement >20%. Three patients (2.5%) experienced periprocedural mortality and 13 patients (10.6%) did not show an improvement in QOL of >20%. The independent predictors correlated to poor outcomes were: DM (P=0.028), creatinine clearance ≤ 46 ml/min (P=0.002), and preexisting intraventricular conduction delay (IVCD) (P=0.017) and post-procedural CrCl ≤ 49ml/min (P= 0.011).
Conclusions: Our study concluded that certain preoperative risk factors and postoperative complications can predict patients' outcomes after TAVI. The independent predictors of poor outcomes were pre-procedural factors (pre-existing DM, chronic kidney disease (CKD) with CrCl ≤ 46 ml/min, and pre-existing IVCD) and a post-procedural factor which was CrCl ≤ 49 ml/min.