"Development of a scoring system for predicting high residual gradient " by Houman Khalili, Amer N. Kadri et al.
 

Development of a scoring system for predicting high residual gradient at pre-discharge echocardiography following TAVR

Document Type

Conference Proceeding

Publication Date

3-2022

Publication Title

Journal of the American College of Cardiology

Abstract

Background: Elevated echocardiographic mean transvalvular gradient (MG) after transcatheter aortic valve replacement (TAVR) has been incorporated as a measure of valve performance and success. Several factors may contribute to elevated gradient apart from type and size of TAVR. We sought to develop a score system to predict elevated echo MG at discharge post-TAVR.

Methods: Data on 5,191 patients undergoing native or valve-in-valve (ViV) TAVR were collected from nine institutions in a multicenter analysis. We examined clinical, echo, and valve related factors that were associated with elevated TAVR MG (≥ 20 mmHg). Model was internally evaluated using bootstrap method. Kaplan-Meier estimates of survival at 3 years for high (≥5) and low scores were plotted, and STS adjusted hazard ratios were calculated.

Results: Five baseline or procedural variables were independently associated with elevated post TAVR MG at discharge echo: age < 75, stroke volume > 60 ml, MG > 45 mmHg, TAVR type, small TAVR size, and ViV TAVR. Model demonstrated good calibration and discrimination (C statistics 0.88, bootstrapped 95% confidence interval (CI) 0.84-0.93). A risk score system, derived from the model, demonstrated good calibration and discrimination (C statistics 0.89). The 3-year survival was similar between the high and low score groups (adjusted HR 0.72, 95% CI 0.49-1.07, p=0.10).

Conclusion: This score system may be a useful tool for prediction of high echo gradient post TAVR. External validation of the score is needed.

Volume

79

Issue

9 Supplement

First Page

662

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