Transcatheter aortic valve replacement (TAVI) - Risk factors for 90-day-mortality

Transcatheter aortic valve implantation (TAVI) has emerged as a promising new treatment option for patients being "too sick" for surgery, with an almost exponentially increasing number of cases done in the recent years. While procedural success is satisfying in any series reported, there still is a lack of information concerning proper patient selection for these procedures. All operations were performed at the Dept. of Cardiovascular Surgery, German Heart Center Munich. From July 2007 to February 2010, a total of 368 patients had transcatheter procedures, 300 of them completed the 90-day-follow-up. Their mean age was 81+/-6 years, 62.7% of them being female. The CoreValve prosthesis was implanted in 213 patients (71%), the femoral route was predominantly used (65%). Among preoperative characteristics, only advanced NYHA-class and tricuspid regurgitation more than moderate were indicators for increased 90-day-mortality. TAVI has become an increasingly safe alternative to open heart aortic valve replacement in patients at high risk for conventional surgery. While there still is room for improvement of intraprocedural steps, the only predictive risk factors for 90-day-mortality were NYHA class IV and high grade tricuspid insufficiency, thus indicating that TAVI puts the patient at an unaccountable high risk.