Clinical Factors and Outcomes When Real-World Heart Teams Overruled STS Risk Scores in TAVR Cases.

Document Type


Publication Date


Publication Title

Journal of interventional cardiology


Aortic Valve; Aortic Valve Stenosis; Frailty; Heart Valve Prosthesis Implantation; Humans; Lung Diseases; Obesity, Morbid; Retrospective Studies; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome; cards; cards publication; oregon; portland; psvmc; pshmc; spokane; washington; renton; swedish heart; swedish; pmrc


Objectives: This study was conducted to determine why heart teams recommended transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) for patients at low predicted risk of mortality (PROM) and describe outcomes of these cases.

Background: Historically, referral to TAVR was based predominately on the Society of Thoracic Surgeons (STS) risk model's PROM >3%. In selected cases, heart teams had latitude to overrule these scores. The clinical reasons and outcomes for these cases are unclear.

Methods: Retrospective data were gathered for all TAVR and SAVR cases conducted by 9 hospitals between 2013 and 2017.

Results: Cases included TAVR patients with STS PROM >3% (

Conclusions: Heart teams recommended TAVR in patients with STS PROM ≤3% primarily due to frailty, hostile chest, severe lung disease, and/or morbid obesity. Similar postoperative outcomes between these patients and those with STS PROM >3% suggest that decisions to overrule STS PROM ≤3% were merited and may have reduced SAVR 30-day mortality rate.

Clinical Institute

Cardiovascular (Heart)