title: Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure.
  
  
  OBJECTIVE
  To identify predictors of 6-month poor clinical outcomes after TAVI.
  
  
  METHODS
  Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes.
  
  
  RESULTS
  We included 163 patients (mean age, 79.9 ± 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 ± 11.4%). The primary endpoint occurred in 49 patients (mean age, 83 ± 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure ≥60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation ≥2/4 (OR 0.07) demonstrated a protective effect.
  
  
  CONCLUSIONS
  Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection.
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France. Electronic address: vincent.auffret@chu-rennes.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.affiliation: CHU de Rennes, Service de Pharmacologie Clinique, Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Laurent
authors.affiliation: CHU de Rennes, Service de Gériatrie, Rennes, France.
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Sost
authors.affiliation: CHU de Rennes, Service de Chirurgie Cardiaque, Thoracique et Vasculaire, Rennes, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Beneux
authors.affiliation: CHU de Rennes, Service de Chirurgie Cardiaque, Thoracique et Vasculaire, Rennes, France.
authors.forename: Majid
authors.initials: M
authors.lastname: Harmouche
authors.affiliation: CHU de Rennes, Service de Chirurgie Cardiaque, Thoracique et Vasculaire, Rennes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Verhoye
authors.affiliation: Inserm, U1099, Rennes, France; Université de Rennes 1, LTSI, Rennes, France; CHU de Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France; Inserm, CIC-IT804, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D018579:Patient Selection; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000401:mortality / Q000503:physiopathology
keywords: Aortic regurgitation; Aortic stenosis; Insuffisance aortique; Outcomes; Résultat; Sténose aortique; Transcatheter aortic valve implantation; Valve aortique percutanée