A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry

Koichi Maeda; Hiraku Kumamaru; Shun Kohsaka; Kazuo Shimamura; Isamu Mizote; Kizuku Yamashita; Ai Kawamura; Takashi Mukai; Daisuke Nakamura; Yasuharu Takeda; Hideyuki Shimizu; Yasushi Sakata; Toru Kuratani; Shigeru Miyagawa; Yoshiki Sawa

doi:10.1016/j.jacasi.2022.06.002

A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry

JACC Asia. 2022 Oct 4;2(5):635-644. doi: 10.1016/j.jacasi.2022.06.002. eCollection 2022 Oct.

Authors

Affiliations

¹ Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
² Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
³ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
⁴ Department of Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan.
⁵ Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.

Abstract

Background: Although transcatheter aortic valve replacement (TAVR) has demonstrated favorable outcomes in randomized studies, there remains a sizable group of patients in whom TAVR may be futile. Characterizing the survival rate in a wide array of patients undergoing TAVR can help develop effective strategies for improving the allocation of medial resources.

Objectives: The aim of this study was to develop a risk model to estimate 1-year mortality after TAVR from a representative nationwide registry in Japan.

Methods: The J-TVT (Japan Transcatheter Valve Therapies) registry contains complete data, including 1-year outcomes, on patients undergoing TAVR in Japan. A total of 17,655 patients underwent TAVR between 2013 and 2018. They were randomly divided into 2 groups in a 7:3 ratio to form a derivation cohort of 12,316 patients and a validation cohort of 5,339 patients. A risk model was constructed for 1-year mortality in the derivation cohort, and its discrimination and calibration were assessed in the validation cohort.

Results: The mean age of all registered patients was 84.4 years, and 68.8% were women. The mean body size area was 1.43 m², and the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 7.3%. The estimated 1-year survival was 91.8%; 202 and 1,316 deaths were observed at 30 days and 1 year, respectively; The estimated C index for the developed model was 0.733 (95% CI: 0.709-0.757) in the validation cohort, with good calibration.

Conclusions: A prediction model for 1-year survival following TAVR derived from a national clinical database performed well and should aid physicians managing TAVR patients.

Keywords: AS, aortic valve stenosis; BMI, body mass index; BSA, body size area; EuroSCORE, European System for Cardiac Operative Risk Evaluation; NYHA, New York Heart Association; STS PROM, Society of Thoracic Surgeons Predicted Risk of Mortality; TAVR, transcatheter aortic valve replacement; prediction model; registry; transcatheter aortic valve replacement.