Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity

Kush P. Patel, Thomas A. Treibel, Paul R. Scully, Michael Fertleman, Samuel Searle, Daniel Davis, James C. Moon, Michael J. Mullen

Producción científica: Contribución a una revistaArtículo de revisiónrevisión exhaustiva

14 Citas (Scopus)

Resumen

Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.

Idioma originalEnglish
Número de artículoe01
PublicaciónInterventional Cardiology Review
Volumen17
DOI
EstadoPublished - 2022
Publicado de forma externa

Nota bibliográfica

Funding Information:
Disclosure: KPP and PRS are supported by a clinical research training fellowship from the British Heart Foundation. KPP has received a project grant from Edwards Lifesciences. TAT is supported by a BHF Intermediate Research Fellowship (FS/19/35/34374). JCM is directly and indirectly supported by the UCLH NIHR Biomedical Research Centre and Biomedical Research Unit at UCLH and Barts, respectively. MM has received grants and personal fees from Edwards Lifesciences, and personal fees from Abbott Vascular. Received: 25 May 2021 Accepted: 5 October 2021 Citation: Interventional Cardiology 2022;17:e01. DOI: https://doi.org/10.15420/icr.2021.15 Correspondence: Michael J Mullen, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK. E: mmullen@nhs.net Open Access: This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

Publisher Copyright:
© 2022 RADCLIFFE CARDIOLOGY.

ASJC Scopus Subject Areas

  • Cardiology and Cardiovascular Medicine

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