Shamekhi Jasmin, Ebert Marius, Lorek Angelina, Eckardt Irina, Al-Kassou Baravan, Basha Mustafa Mousa, Weber Marcel, Silaschi Miriam, Bakhtiary Farhad, Nickenig Georg, Zimmer Sebastian
Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Heart Center Bonn, Cardiac Surgery, University Hospital Bonn, Bonn, Germany.
Clin Res Cardiol. 2025 Jun 23. doi: 10.1007/s00392-025-02698-1.
Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations.
This study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period.
Between January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure).
The median waiting time for TAVR was 41 days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29 days. By comparison, 30 day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of ≥ 5 identified high-risk patients with a pre-TAVR mortality rate of 12.6%.
The mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.
有症状的严重主动脉瓣狭窄（AS）是一种危及生命的疾病，需要及时就医。虽然经导管主动脉瓣置换术（TAVR）是一种有效的治疗方法，但由于等待期死亡率数据有限且缺乏可行的风险评估，目前的手术安排做法往往没有考虑到个体患者的风险状况。因此，对于高危患者群体来说，未被优先安排的等待时间可能长得令人无法接受。
本研究旨在评估等待TAVR的有症状严重AS患者的死亡率，并确定在此期间实用的临床风险预测因素。
在2019年1月至2023年12月期间，2454例有症状严重AS患者在波恩心脏中心经过跨学科心脏团队讨论后被安排接受TAVR。评估等待期的死亡率，并将存活者（接受TAVR的患者）的特征与非存活者（手术前死亡的患者）进行比较。
TAVR的中位等待时间为41天。共有105例（4.3%）患者在等待期死亡，中位死亡时间为29天。相比之下，包括干预在内的TAVR术后30天死亡率为1.7%。多变量回归分析确定了TAVR术前死亡率的独立预测因素，包括左心室射血分数降低、估计肾小球滤过率下降、二尖瓣反流、三尖瓣反流和晚期心力衰竭症状。纳入这些参数的IMPACT评分强烈预测了结果，死亡率的风险比为2.1，大大优于欧洲心脏手术风险评估系统II（EuroSCORE II）和胸外科医师协会预测模型（STS-PROM）。IMPACT评分≥5可识别出TAVR术前死亡率为12.6%的高危患者。
等待TAVR的有症状严重AS患者的死亡率高得令人无法接受。使用IMPACT评分可以实现精确的风险分层，识别出需要紧急或优先干预以改善预后的患者。
