When does transapical aortic valve replacement become a futile procedure? An analysis from a national registry

Augusto D'Onofrio, Stefano Salizzoni, Marco Agrifoglio, Vincenzo Lucchetti, Francesco Musumeci, Giampiero Esposito, Paolo Magagna, Marco Aiello, Carlo Savini, Mauro Cassese, Mattia Glauber, Giuseppe Punta, Ottavio Alfieri, Davide Gabbieri, Domenico Mangino, Andrea Agostinelli, Ugolino Livi, Omar Di Gregorio, Alessandro Minati, Giuseppe FaggianClaudia Filippini, Mauro Rinaldi, Gino Gerosa

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives Patient selection is crucial to achieve good outcomes and to avoid futile procedures in patients undergoing transcatheter aortic valve replacement. The aim of this multicenter retrospective study was to identify independent predictors of 1-year mortality in patients surviving after transapical transcatheter aortic valve replacement. Methods We analyzed data from the Italian registry of transapical transcatheter aortic valve replacement that includes patients undergoing operation in 21 centers from 2007 to 2012. Futility was defined as mortality within 1 year after transapical transcatheter aortic valve replacement in patients surviving at 30 days. Thirty-day survivors were divided in 2 groups: futility (group F) and nonfutility (group NF). Cox proportional hazard regression analysis was performed to identify independent predictors of futility. Results We analyzed data from 645 patients with survival of 30 days or more after transapical transcatheter aortic valve replacement. Groups F and NF included 60 patients (10.8%) and 585 patients (89.2%), respectively. Patients in group F were more likely to have insulin-dependent diabetes (15% vs 7.2%, P =.03), creatinine 2.0 mg/dL or greater or dialysis (18.3% vs 8.2%, P =.01), logistic European System for Cardiac Operative Risk Evaluation greater than 20% (66.7% vs 50.3%, P =.02), preoperative rhythm disorders (40% vs 25.3%, P =.03), critical preoperative state (8.3% vs 1.8%, P =.002), and left ventricular ejection fraction less than 30% (15% vs 2.9%, P

Original languageEnglish
Pages (from-to)973-980
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number3
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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