Calculating Risk for Poor Outcomes After Transcatheter Aortic Valve Replacement.

OBJECTIVE: To outline the tools available to help understand the risk of transcatheter aortic valve replacement (TAVR) and the gaps in knowledge regarding TAVR risk estimation.
METHODS: Review of the literature.
RESULTS: Two models developed and validated by the American College of Cardiology can be used to estimate the risk of short-term mortality, a 6-variable in-hospital model designed for clinical use and a 41-variable 30- day model designed primarily for site comparisons and quality improvement. Importantly, neither model should be used to inform the choice of TAVR versus surgical aortic valve replacement. Regarding long-term outcomes, a risk model to estimate risk of dying or having a persistently poor quality of life at 1 year after TAVR has been developed and validated. Factors that most significantly increase a patient's risk for poor outcomes are very poor functional status prior to TAVR, requiring home oxygen, chronic renal insufficiency, atrial fibrillation, dependencies in activities of daily living, and dementia. If a patient has ≥ 2 or 3 major risk factors for a poor outcome, this risk and the uncertainty about the degree of recovery expected after TAVR should be discussed with the patient (and family).
CONCLUSION: It is important to understand the patient factors that most strongly drive risk of poor outcomes after TAVR and use this information to set appropriate expectations for recovery.