TAVI May Be Safe for Sickest Patients
High surgical risk scores are no barrier for transcatheter aortic valve implantation (TAVI), according to one center's experience.
Patients with a EuroSCORE over 40% had an overall 30-day mortality rate after the valve replacement procedure of 6.5% with and 5.7% without cardiogenic shock, Miralem Pasic, MD, PhD, of the German Heart Institute in Berlin, and colleagues found.
Although such high risk scores are often considered a contraindication, 54% and 56% of these patients survived to year two, respectively, the group reported in the January issue of the Annals of Thoracic Surgery.
"From our initial experience in very high-risk patients, TAVI seems to provide much better results than medical treatment or conventional aortic valve replacement, which carries a relatively high operative mortality in these specific patients," they wrote.
These patients should be evaluated for a transcatheter valve if technically feasible in terms of annular size, the group argued.
"The predictive score systems do not correlate with the data of early mortality in patients undergoing TAVI and should not be used to exclude patients from this new therapeutic option," they wrote. "In fact, a high score is the real indication for TAVI."