Development and Validation of a Predictive Risk Score for Poor Functional Outcome After Transcatheter Aortic Valve Replacement in Elderly Patients.

PURPOSE: Despite the success of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a subset of older adults experience poor functional recovery. We aimed to develop and validate a pragmatic clinical risk score to predict poor 6-month functional outcomes in this population. METHODS: We conducted a retrospective cohort study of 204 elderly patients (≥65 years, 106 males and 98 females) with severe AS who underwent TAVR at our center between March 2021 and March 2024. The primary endpoint was poor functional outcome at 6 months, defined as a composite of failure to improve left ventricular ejection fraction (LVEF) by >10% and failure to increase 6-minute walk test (6MWT) distance by >50 meters. Patients were randomly split into a training cohort (n=143) and a validation cohort (n=61). LASSO regression was used in the training cohort to identify predictors and construct the TAVR-PRO (Transcatheter Aortic Valve Replacement - Poor Recovery Outcome) risk score. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. A secondary endpoint of 1-year all-cause mortality was analyzed using Kaplan-Meier curves. RESULTS: Five independent predictors were incorporated into the TAVR-PRO score: advanced age (≥80 years), Clinical Frailty Scale (CFS) >4, NT-proBNP >3000 pg/mL, coronary artery disease, and chronic kidney disease (eGFR < 45 mL/min/1.73m2). The score demonstrated good discrimination in both the training (AUC = 0.88) and validation cohorts (AUC = 0.86), with excellent calibration. Higher scores were significantly associated with poor functional outcome and increased 1-year all-cause mortality (P < 0.001). CONCLUSION: The TAVR-PRO score, based on five readily available variables, is a simple and effective tool for predicting poor functional outcomes and mortality after TAVR in older adults. This score can aid in shared decision-making, patient counseling, and identifying high-risk individuals for targeted interventions.