Key result
TAVI futility affects ~5% of patients and is linked to COPD, AFib, and renal dysfunction.
Why the study?
TAVI is contraindicated when post-operative life expectancy is under one year due to futility, motivating the identification of variables associated with procedural futility.
Cohort (n=649)
No
Odds Ratio: 4.637 (95% CI 2.026–10.609)
p-value: p=<0.001
Procedural futility after TAVI occurs in approximately 5.4% of patients and is strongly associated with baseline comorbidities including COPD, atrial fibrillation, and malnutrition.
May aid risk stratification for TAVI candidates; leaves open whether these factors should guide selection pending prospective validation.
Background Transcatheter aortic valve implantation (TAVI) is the most common therapeutic alternative to treat severe aortic stenosis. However, TAVI implantation is contraindicated in patients with a post-operative life expectancy of less than one year, as it is considered a ‘futile’ intervention. Purpose The aim of our study was to identify variables related to the futility of this procedure. Methods We conducted a retrospective study of 649 patients who underwent TAVI implantation at our centre between 2013 and 2024. The survival after discharge was analysed (with a median follow-up of 40 months). Mortality during follow-up was classified according to the time of occurrence into three groups: periprocedural mortality (<30 days), early mortality (30 days to 1 year) and late mortality (>1 year) according to the Valve Academic Research Consortium 3 (VARC-3) document. Procedural futility was defined as death during the first year after implantation not due to procedure-related complications. Results Mean age was 80.6±5.4 years and 54.9% were women. We analyzed comorbid baseline clinical variables as well as baseline laboratory tests. Comorbidity was defined according to Charlson index and nutritional status was evaluated according to CONUT score. Procedural futility was seen in 35 patients (5.4%). The distribution of the baseline variables related to mortality during follow-up are shown in the table, as well as their relationship with procedural futility. In multivariate analysis, variables associated with procedural futility were: glomerular filtration rate (OR 0.982; 95% CI: 0.961-1.003, p=0.091), chronic obstructive pulmonary disease (COPD) (OR 4.540; 95% CI: 2.048-10.066, p<0.001), albumin (OR 0.373; 95% CI: 0.187-0.744; p=0.005) and previous atrial fibrillation (OR 4.637; 95% CI: 2.026-10.609; p<0.001). Conclusions The futility of TAVI implantation in our centre was not negligible (5.4%), and was related to a history of chronic renal disease, COPD, malnutrition and atrial fibrillation. It is important to consider the futility of the intervention in certain patients in order to avoid harm and optimise available resources.
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Nuevo-Gallardo et al. (2025) conducted a cohort in Severe aortic stenosis (n=649). Previous atrial fibrillation vs. No previous atrial fibrillation was evaluated on Procedural futility (death during the first year after implantation not due to procedure-related complications) (OR 4.637, 95% CI 2.026-10.609, p=<0.001). Procedural futility after TAVI occurred in 5.4% of patients and was strongly associated with previous atrial fibrillation (OR 4.637; 95% CI 2.026-10.609) and COPD.
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