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Predictors of TAVI Futility in a Tertiary Centre
Session:
Sessão de Posters 31 - Intervenção transcateter na válvula aórtica: acesso, futilidade e anatomia complexa
Speaker:
Tomás M. Carlos
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Tomás M. Carlos; Bernardo Resende; Luísa Gomes Rocha; Mafalda Griné; Gonçalo Terleira Batista; Ana Luísa Silva; Tatiana Santos; Mariana Simões; Luís Leite; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif">Transcatheter aortic valve implantation (TAVI) has expanded rapidly worldwide and is now being offered to increasingly older and more fragile patients with severe aortic stenosis. Although TAVI provides substantial benefits, it may be futile in patients with <1-year life expectancy or an expected functional improvement <25%. Existing prognostic scores offer support in candidate selection, yet their ability to fully capture individual clinical complexity remains limited. This study aimed to identify additional baseline clinical predictors of TAVI futility in a real-world cohort, beyond conventional nutritional and frailty scores, to improve pre-procedural evaluation and support more informed decision-making.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif">We performed a single<span style="font-family:"Cambria Math",serif">-</span>centre retrospective study including 639 consecutive patients undergoing TAVI between March 2020 and September 2023. After excluding those without follow<span style="font-family:"Cambria Math",serif">-</span>up or those who died during the index hospitalisation, 537 patients were analysed. Futility was defined as all-cause mortality at 1 year. Baseline characteristics were compared between groups, and predictors of 1-year mortality were assessed using binary logistic regression. Survival differences across subgroups were evaluated using Kaplan<span style="font-family:"Cambria Math",serif">-</span>Meier analysis.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif">One-year mortality occurred in 42 patients (7.8%). Compared with non-futile cases, these patients had higher rates of stage IV–V chronic kidney disease (21.4% vs 10.5%; p = 0.042), prior pacemaker implantation (26.2% vs 11.7%; p = 0.007), and higher NT-proBNP levels (3149 vs 1765 pg/mL; p = 0.002), although the latter was not significant after adjustment. ROC analysis showed limited discriminative value of LVEF, with a Youden index of 21% and AUC 0.418 (p = 0.09). However, in multivariable analysis, lower LVEF remained a significant predictor of futility (OR 0.97 per %, CI 0.94–1.00; p = 0.045), together with stage IV–V chronic kidney disease (OR 2.77; CI 1.17–6.59; p = 0.021) and prior pacemaker implantation (OR 3.64; CI 1.54–8.61; p = 0.003). Kaplan–Meier curves confirmed reduced survival across these high-risk groups.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Aptos,sans-serif">One<span style="font-family:"Cambria Math",serif">-</span>year mortality following TAVI was strongly associated with advanced chronic kidney disease, prior pacemaker implantation, and reduced LVEF. These readily identifiable baseline characteristics may help refine pre<span style="font-family:"Cambria Math",serif">-</span>procedural risk stratification and support clinical decision<span style="font-family:"Cambria Math",serif">-</span>making regarding TAVI futility.</span></span></p>
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