Ferry Charlie, Fiery-Fraillon Jade, Togni Mario, Cook Stephane
Department of Cardiology, University & Hospital Fribourg, Fribourg, Switzerland.
Institute of Higher Education and Research in Healthcare-IUFRS, Lausanne, Switzerland.
PLoS One. 2025 Jan 9;20(1):e0313399. doi: 10.1371/journal.pone.0313399. eCollection 2025.
BACKGROUND: Transcatheter Aortic Valve Implantation (TAVI) procedures are rapidly expanding, necessitating a more extensive stratification of patients with aortic stenosis. Especially in the high-risk group, some patients fail to derive optimal or any benefits from TAVI, leading to the risk of futile interventions. Despite consensus among several experts regarding the importance of recognizing and anticipating such interventions, the definition, and predictive criteria for futility in TAVI remain ambiguous. AIM: The purpose of this study is to explore the literature addressing the definition, predictive criteria, and medical predictive models for futility in cases of TAVI. DESIGN: A scoping review was conducted by two researchers and reported in accordance with the PRISMA-ScR guidelines. ELIGIBILITY CRITERIA: Studies addressing futility in TAVI, including definitions, predictive variables, and models, were included without restrictions on study design but were excluded study only on surgical valve replacement, valve in valve or aortic stenosis causes by other pathology than calcification. INFORMATION SOURCES: We identified 129 studies from five key sources: CINAHL, PUBMED, the Cochrane Library, ClinicalTrials.gov, and EMBASE. The literature search was conducted in two rounds-first in February 2024 and again in October 2024-using no restrictions on the year of publication or the language of the studies. Additional references were included through cross-referencing. RESULTS: The definition of futility is not unanimous, although most researchers agreed on 1-year survival as a cutoff. The majority of studies focused on single variables that can predict 1-year survival, employing either prospective or retrospective designs. Frailty was the major concept studied. Numerous predictive models have been identified, but no consensus was found. CONCLUSION: Futility concepts generate interest in the TAVI procedure. In this review, numerous articles state that 1-year mortality serves as a cutoff to define futile procedures. Some variables, cardiac or otherwise, are independent predictors of 1-year mortality. Medical predictive models showed moderate sensitivity and specificity, except for machine learning, which shows promise for the future. However, few articles delve deeply into non-quantifiable parameters such as patient goals and objectives or ethical questions. More studies should focus on these parameters.
背景:经导管主动脉瓣植入术(TAVI)的应用正在迅速扩大,这就需要对主动脉瓣狭窄患者进行更广泛的分层。特别是在高危组中,一些患者无法从TAVI中获得最佳效果或任何益处,从而导致无效干预的风险。尽管几位专家就认识和预测此类干预的重要性已达成共识,但TAVI中无效的定义和预测标准仍不明确。 目的:本研究的目的是探讨有关TAVI病例中无效的定义、预测标准和医学预测模型的文献。 设计:由两名研究人员进行了一项范围综述,并按照PRISMA-ScR指南进行报告。 纳入标准:纳入涉及TAVI中无效的研究,包括定义、预测变量和模型,对研究设计无限制,但仅关于外科瓣膜置换、瓣中瓣或由钙化以外的其他病理原因引起的主动脉瓣狭窄的研究被排除。 信息来源:我们从五个主要来源确定了129项研究:CINAHL、PUBMED、Cochrane图书馆、ClinicalTrials.gov和EMBASE。文献检索分两轮进行——第一次在2024年2月,第二次在2024年10月——对研究的发表年份或语言没有限制。通过交叉引用纳入了其他参考文献。 结果:尽管大多数研究人员同意将1年生存率作为临界值,但无效的定义并不统一。大多数研究集中在可预测1年生存率的单一变量上,采用前瞻性或回顾性设计。衰弱是研究的主要概念。已经确定了许多预测模型,但未达成共识。 结论:无效概念引发了对TAVI手术的关注。在本综述中,许多文章指出1年死亡率作为定义无效手术的临界值。一些变量,无论是心脏相关的还是其他方面的,都是1年死亡率的独立预测因素。医学预测模型显示出中等的敏感性和特异性,机器学习除外,机器学习显示出未来的潜力。然而,很少有文章深入探讨不可量化的参数,如患者的目标和目的或伦理问题。更多的研究应关注这些参数。
Ont Health Technol Assess Ser. 2020
Cochrane Database Syst Rev. 2019-12-20
Catheter Cardiovasc Interv. 2020-12
BMC Cardiovasc Disord. 2025-8-30
Sisli Etfal Hastan Tip Bul. 2024-6-28
J Thorac Cardiovasc Surg. 2025-5
EuroIntervention. 2024-4-15
Circ Cardiovasc Interv. 2024-2
Clin Biomech (Bristol). 2023-6