Predicting outcomes of patients undergoing TAVI
Predicting outcomes of patients undergoing TAVI
The primary objective of this dissertation of Kees van Bergeijk was to identify predictors of poor clinical outcomes in patients undergoing TAVI (transcatheter aortic valve replacement) or SAVR (surgical aortic valve replacement).
First, this thesis demonstrated that SAVR patients differed substantially in characteristics and comorbidities compared with TAVI patients, and that the predictors of poor outcomes also differed between these groups.
In addition, it was shown that short-term outcomes after TAVI were comparable between men and women, although this effect depended on the use of anticoagulation therapy before, during, and after the procedure.
Finally, a model was developed to predict the risk of a combined endpoint of lack of symptom improvement together with the occurrence of a poor outcome one year after TAVI. Furthermore, it was found that patients undergoing TAVI who also had COPD, atrial fibrillation, and heart failure often had a low-flow, low-gradient pattern of aortic stenosis, combined with more symptoms and worse outcomes after five years. A cluster analysis revealed that this group frequently had preserved ejection fraction (HFpEF).
The results of this dissertation contribute to improving the prediction of (poor) outcomes in patients undergoing TAVI. With the appropriate type and amount of data, patients at high risk of poor outcomes after this procedure can be better identified. The findings also emphasize that there are still patients who do not benefit from TAVI, and that especially those with multiple comorbidities are at increased risk of worse outcomes.