{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T22:33:47Z","timestamp":1774823627012,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T00:00:00Z","timestamp":1638748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: We tested if a novel combination of predictors could improve the accuracy of outcome prediction after transfemoral transcatheter aortic valve implantation (TAVI). Materials and Methods: This prospective study recruited 169 participants (49% female; median age 81 years). The primary endpoint was midterm mortality; secondary endpoints were acute Valve Academic Research Consortium (VARC)-3 complication rate and post-TAVI in-hospital length of stay (LoS). EuroSCORE II (ESII), comorbidities (e.g., coronary artery disease), eGFR (estimated glomerular filtration rate; based on cystatin C), hemoglobin, creatinine, N-Terminal pro-Brain Natriuretic Peptide (NTproBNP) levels and patient-reported outcome measures (PROMs, namely EuroQol-5-Dimension-5-Levels, EQ5D5L; Kansas City Cardiomyopathy Questionnaire, KCCQ; clinical frailty scale, CFS) at baseline were tested as predictors. Regression (uni- and multi-variate Cox; linear; binary logistic) and receiver operating characteristic (ROC)-curve analysis were applied. Results: Within a median follow-up of 439 (318\u2013585) days, 12 participants died (7.1%). Independent predictors of mortality using multivariate Cox regression were baseline eGFR (p = 0.001) and KCCQ (p = 0.037). Based on these predictors, a Linear Prediction Score (LPS1) was calculated. The LPS1-area under the curve (AUC)-value (0.761) was significantly higher than the ESII-AUC value (0.597; p = 0.035). Independent predictors for LoS &gt; 6 days (the median LoS) were eGFR (p = 0.028), NTproBNP (p = 0.034), and EQ5D5L values (p = 0.002); a respective calculated LPS2 provided an AUC value of 0.677 (p &lt; 0.001). Eighty participants (47.3%) experienced complications. Male sex predicted complications only in the univariate analysis. Conclusions: The combination of KCCQ and eGFR can better predict midterm mortality than ES II alone. Combining eGFR, NTproBNP, and EQ5D5L can reliably predict LoS after TAVI. This novel method improves personalized TAVI risk stratification and hence may help reduce post-TAVI risk.<\/jats:p>","DOI":"10.3390\/medicina57121332","type":"journal-article","created":{"date-parts":[[2021,12,6]],"date-time":"2021-12-06T03:10:38Z","timestamp":1638760238000},"page":"1332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["A Novel Method to Predict Mortality and Length of Stay after Transfemoral Transcatheter Aortic Valve Implantation"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8156-3088","authenticated-orcid":false,"given":"Maria","family":"Zisiopoulou","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Berkowitsch","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Seppelt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas M.","family":"Zeiher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariuca","family":"Vasa-Nicotera","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1007\/s00392-015-0857-9","article-title":"The impact of transcatheter aortic valve implantation on quality of life: Results from the German transcatheter aortic valve interventions registry","volume":"104","author":"Biermann","year":"2015","journal-title":"Clin. Res. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.4244\/EIJY15M09_11","article-title":"Transcatheter aortic valve implantation (TAVI) in Germany 2008\u20132014: On its way to standard therapy for aortic valve stenosis in the elderly?","volume":"11","author":"Eggebrecht","year":"2016","journal-title":"EuroIntervention"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1536\/ihj.20-398","article-title":"Comparison of Procedural and 1-Year Clinical Results of Transcatheter Aortic Valve Implantation Using Prostheses with Different Design of Support Frame","volume":"61","author":"Li","year":"2020","journal-title":"Int. Hear. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e000879","DOI":"10.1136\/openhrt-2018-000879","article-title":"Guideline-defined futility or patient-reported outcomes to assess treatment success after TAVI: What to use? Results from a prospective cohort study with long-term follow-up","volume":"5","author":"Vendrik","year":"2018","journal-title":"Open Heart"},{"key":"ref_5","first-page":"CD013319","article-title":"Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk","volume":"12","author":"Kolkailah","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ahj.2016.10.020","article-title":"Inadequacy of existing clinical prediction models for predicting mortality after transcatheter aortic valve implantation","volume":"184","author":"Martin","year":"2017","journal-title":"Am. Hear. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s40271-014-0055-2","article-title":"Making Decisions About Implantable Cardioverter-Defibrillators from Implantation to End of Life: An Integrative Review of Patients\u2019 Perspectives","volume":"7","author":"Lewis","year":"2014","journal-title":"Patient Patient-Cent. Outcomes Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s40271-018-0320-x","article-title":"Understanding \u2018Good Health care\u2019 from the Patient\u2019s Perspective: Development of a Conceptual Model Using Group Concept Mapping","volume":"12","author":"McCaffrey","year":"2019","journal-title":"Patient Patient-Centered Outcomes Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e006929","DOI":"10.1161\/CIRCINTERVENTIONS.118.006929","article-title":"Length of Stay and Discharge Disposition After Transcatheter Versus Surgical Aortic Valve Replacement in the United States","volume":"11","author":"Arora","year":"2018","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_10","unstructured":"(2020, November 10). F98B G-DRG + Statistiken OPS ICD Erl\u00f6se Kostenstellen. Available online: https:\/\/app.reimbursement.info\/drgs\/F98B."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/1469-0691.12470","article-title":"Early, intermediate and late infectious complications after transcatheter or surgical aortic-valve replacement: A prospective cohort study","volume":"20","author":"Falcone","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/j.amjcard.2018.11.030","article-title":"Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation for Aortic Stenosis","volume":"123","author":"Takagi","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1161\/01.ATV.0000228824.01604.63","article-title":"Increased Expression of Elastolytic Cathepsins S, K, and V and Their Inhibitor Cystatin C in Stenotic Aortic Valves","volume":"26","author":"Helske","year":"2006","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"605257","DOI":"10.3389\/fcvm.2020.605257","article-title":"Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement","volume":"7","author":"Seppelt","year":"2020","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/eurheartj\/ehq427","article-title":"One year follow-up of the multi-centre European PARTNER transcatheter heart valve study","volume":"32","author":"Kappetein","year":"2011","journal-title":"Eur. Hear. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e002875","DOI":"10.1161\/CIRCINTERVENTIONS.115.002875","article-title":"Association of Patient-Reported Health Status With Long-Term Mortality After Transcatheter Aortic Valve Replacement","volume":"8","author":"Arnold","year":"2015","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e007187","DOI":"10.1161\/CIRCOUTCOMES.120.007187","article-title":"Practical Application of Patient-Reported Health Status Measures for Transcatheter Valve Therapies. Insights From the Soci-ety of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapies Registry","volume":"14","author":"Hejjaji","year":"2021","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"Nashef","year":"2012","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_19","first-page":"261","article-title":"Long-term follow-up of quality of life in high-risk patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis","volume":"15","author":"Goudzwaard","year":"2018","journal-title":"J. Geriatr. Cardiol."},{"key":"ref_20","unstructured":"Van Reenen, M., and Janssen, B. (2015). EQ-5D-5L-User-Guide, EuroQol Research Foundation. Version 2.1."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1161\/CIRCHEARTFAILURE.112.970053","article-title":"Use of the Kansas City Cardiomyopathy Questionnaire for Monitoring Health Status in Patients With Aortic Stenosis","volume":"6","author":"Arnold","year":"2013","journal-title":"Circ. Hear. Fail."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e001008","DOI":"10.1136\/openhrt-2019-001008","article-title":"Trial protocol for the validation of the \u2018Toronto Aortic Stenosis Quality of Life (TASQ) Questionnaire\u2019 in patients undergoing surgical aortic valve replacement (SAVR) or transfemoral (TF) transcatheter aortic valve implantation (TAVI): The TASQ registry","volume":"6","author":"Frank","year":"2019","journal-title":"Open Hear."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/j.amjcard.2017.12.035","article-title":"Clinical Frailty as an Outcome Predictor After Transcatheter Aortic Valve Implantation","volume":"121","author":"Rogers","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1161\/CIRCULATIONAHA.116.025630","article-title":"Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement","volume":"135","author":"Shimura","year":"2017","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"VARC-3 Writing Committee, G\u00e9n\u00e9reux, P., Piazza, N., Alu, M.C., Nazif, T., Hahn, R.T., Pibarot, P., Bax, J.J., Leipsic, J.A., and Blanke, P. (2021). Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research. Eur. Hear. J., 42, 1825\u20131857.","DOI":"10.1093\/eurheartj\/ehaa799"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1001\/jamacardio.2021.0372","article-title":"Comparison of New York Heart Association Class and Patient-Reported Outcomes for Heart Failure With Reduced Ejection Fraction","volume":"6","author":"Greene","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1016\/j.amjcard.2019.12.040","article-title":"Prognostic Implications of Renal Dysfunction in Patients With Aortic Stenosis","volume":"125","author":"Vollema","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1016\/j.ehj.2004.09.001","article-title":"Role of BNP in patients with severe asymptomatic aortic stenosis","volume":"25","author":"Patel","year":"2004","journal-title":"Eur. Hear. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1093\/eurheartj\/ehi236","article-title":"Relation of N-terminal pro B-type natriuretic peptide to progression of aortic valve disease","volume":"26","author":"Weber","year":"2005","journal-title":"Eur. Hear. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1161\/01.CIR.0000060533.79248.0C","article-title":"Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis","volume":"107","author":"Gerber","year":"2003","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ijcard.2017.06.024","article-title":"Prognostic impact of anemia and iron-deficiency anemia in a contemporary cohort of patients undergoing transcatheter aortic valve implantation","volume":"244","author":"Rheude","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Al-Rashid, F., Kahlert, P., Selge, F., Hildebrandt, H., Patsalis, P.-C., Totzeck, M., Mummel, P., Rassaf, T., and J\u00e1nosi, R.A. (2016). Risk Assessment of Patients Undergoing Transfemoral Aortic Valve Implantation upon Admission for Post-Interventional Intensive Care and Surveillance: Implications on Short- and Midterm Outcomes. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167072"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s40271-016-0194-8","article-title":"Symptoms and Functional Limitations in the First Year Following a Myocardial Infarction: A Qualitative Study","volume":"10","author":"Gwaltney","year":"2016","journal-title":"Patient Patient-Centered Outcomes Res."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/12\/1332\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:40:05Z","timestamp":1760168405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/12\/1332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,6]]},"references-count":33,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["medicina57121332"],"URL":"https:\/\/doi.org\/10.3390\/medicina57121332","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,6]]}}}