Tumour necrosis factor-alpha serum level is an independent predictor of medium-term all-cause mortality after transcatheter aortic valve replacement

Background: Transcatheter aortic valve implantation (TAVI) is a suitable treatment for patients with severe aortic stenosis and severely increased operative risk. There is need for a better preoperative risk assessment for TAVI candidates. Aim: To determine whether Tumour necrosis factor-alfa (TNF alpha) is an independent predictor of survival 500 days after TAVI. Methods: Sixty patients undergoing TAVI were enrolled in the study. TNF alpha was determined. The CT measured low-density muscle fraction (LDM%) of the psoas muscle was determined. Operative risk assessment by Logistic EuroSCORE, EuroSCORE II, and STS score was performed. Frailty scores (FRAIL scale and Barthel index) were determined. Results: Mean age was 81.01 +/- 7.54 years. Twenty-six (43.3%) of the patients were males. In the univariable analyses, FRAIL scale and Barthel index were no predictors of survival after TAVI. In the multivariable analysis, including EuroSCORE II, LDM% and TNF alpha serum concentration, TNF alpha serum level was an independent predictor of survival 500 days after TAVI (HR: 3.167; 95%: 1.279-7.842; p = 0.013). The multivariable analysis, including TNF alpha as a categorical variable, showed that compared to patients in the conjugated first and second TNF alpha serum level tertile, patients in the third tertile had a hazard ratio (HR) of 10.606 (95%CI: 1.203 - 93.467) (p = 0.033). Conclusion: TNF alpha is an incremental independent predictor of long-term survival after TAVI.