{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T22:18:08Z","timestamp":1785449888849,"version":"3.56.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Bonn"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>This study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Between January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The median waiting time for TAVR was 41\u00a0days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29\u00a0days. By comparison, 30\u00a0day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of\u2009\u2265\u20095 identified high-risk patients with a pre-TAVR mortality rate of 12.6%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00392-025-02698-1","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T06:28:10Z","timestamp":1750660090000},"page":"1565-1573","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Fighting time: the critical importance of pre-TAVR mortality risk prediction"],"prefix":"10.1007","volume":"114","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5724-9814","authenticated-orcid":false,"given":"Jasmin","family":"Shamekhi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Ebert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Lorek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baravan","family":"Al-Kassou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Mousa","family":"Basha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Silaschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhad","family":"Bakhtiary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Nickenig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Zimmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"issue":"388","key":"2698_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.131155","volume":"1","author":"A Chatterjee","year":"2023","unstructured":"Chatterjee A, Kazui T, Acharya D (2023) Growing prevalence of aortic stenosis - question of age or better recognition? 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G. Nickenig and S. Zimmer have received speaker honoraria from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi, Novartis, Pfizer, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. M. Silaschi received research grants from Medtronic, LSI solutions and Artivion. The other authors report no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Patients with severe aortic stenosis awaiting TAVR face high mortality, highlighting the need for timely intervention. The newly established IMPACT score predicts adverse outcomes, enabling risk stratification and prioritization of high-risk individuals. This tool aids in clinical decision-making, optimizing perioperative care and guiding resource allocation. Its implementation may reduce wait list mortality by improving triage and early intervention strategies. Further validation and research are needed to refine its predictive accuracy.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}