Background

Transcatheter aortic valve replacement (TAVR) is the preferred treatment for most patients with aortic stenosis deemed at intermediate or higher risk for surgical aortic valve replacement (SAVR). Determination of the risk of SAVR is mainly based on the Society of Thoracic Surgeons (STS) risk calculator. However, federal regulations permit the heart team latitude to offer TAVR for patients with ≤3% predicted risk of mortality (PROM) whose perceived risk is not adequately accounted for by the STS risk model. Limited data is available on the clinical characteristics and outcomes of these patients Methods

The study group involved 2,539 patients who underwent TAVR from 2013 to 2017 within 7 hospitals in 5 Western states in the Providence St. Joseph Health system. The local TAVR site staff completed surveys identifying the clinical factors driving the heart team's decision to proceed with TAVR. Clinical data was also collected per the TVT registry requirements. Results

We identified 332 TAVR patients with STS PROM ≤3% and 2,207 patients with STS PROM >3%. The percentage of TAVR patients with an STS PROM increased over time from 5.1% in 2013 to 16.6% in 2017. The most common factors (≥1 possible) influencing the heart team's decision to proceed with TAVR in the ≤3% STS PROM group were frailty (63%), hostile chest (23%), severe lung disease (14%), morbid obesity (10%), and liver disease (8%). The baseline characteristics and outcomes of both groups are listed in the Table. Conclusion

The proportion of TAVR patients with STS PROM ≤3% tripled from 2013 to 2017. In comparison to those with STS PROM >3%, they were younger and more often men. The most common reasons driving the decision to favor TAVR over SAVR were frailty, hostile chest, and severe lung disease. TAVR patients with STS PROM ≤3% had shorter hospital stays and were more likely to be alive at 1 year.