Why the study?
A cohort of patients derives no symptomatic benefit or dies after TAVI, making the procedure futile, exposing patients to unnecessary risk, and leading to inefficient healthcare resource utilisation.
Systematic evaluation of frailty and comorbidities is essential to identify patients for whom TAVI may be futile, thereby avoiding unnecessary risk and inefficient resource utilization.
Highlights futility risk in high-risk TAVI; leaves open validated selection tools for prospective research.
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.
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Patel et al. (2022) studied this question.
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