Background and Outcomes of TAVR in Low-Risk Score Patients

Kyoko Shigetomi＊	Joji Ito＊	Shinsuke Kotani＊
Minoru Tabata＊, ＊＊

(Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center＊, Urayasu, Japan, and Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine＊＊, Tokyo, Japan)

Objective: This study aimed to examine the background and outcomes of transcatheter aortic valve replacement (TAVR) in patients with low-risk scores. Methods: We retrospectively reviewed 69 patients with risk scores of<4% undergoing TAVR in a single institution from January 2016 through June 2021. Results: The mean age of the patients was 81±4.5 years, and 52% of them were women. The reasons for TAVR selection included very old age (≥85 years; 20%); frailty (51%); ascending aortic calcification (4.3%); history of mediastinal radiation therapy (2.8%); and respiratory diseases (10%)． Six patients required early discharge and recovery for another surgery following treatment of aortic stenosis or family members’ care, and 2 patients had an estimated life expectancy of 1-5 years. Also, three patients strongly desired TAVR despite having none of the objective factors that favor TAVR. The median lengths of stay in the ICU and after TAVR were 1 day (1-11 days) and 5 days (3-40 days)． There was neither operative mortality nor a need for aortic valve reintervention. Kaplan–Meier curves showed that the one-year survival rate was 99%, and two-year and three-year survival rates were 97% each. The causes of late death were sepsis, unknown factor, and intracranial hemorrhage. Discussion: The short-term and medium-term outcomes of TAVR with low-risk score patients were favorable although the patient background was poor due to high-risk factors for surgery that were excluded from the risk scores.

 

Jpn. J. Cardiovasc. Surg. 51: 334-338 （2022）

Keywords：aortic valve stenosis; transcatheter aortic valve replacement; transcatheter aortic valve implantation; low-risk