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TAVI Futility Assessment — EECC MCQ

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HardGeneral CardiologyTAVI Futility AssessmentEECC

A 72-year-old man with extensive comorbidities (advanced COPD, dialysis-dependent CKD, metastatic cancer) presents with severe symptomatic AS. His life expectancy is estimated at <12 months. The Heart Team considers whether TAVI is appropriate. What concept guides this decision?

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Correct answer: C — Futility assessment — TAVI should not be offered when comorbidities limit life expectancy or quality of life to the extent that the patient is unlikely to benefit from valve intervention, even if technically feasible

The concept of futility in TAVI is critical to appropriate patient selection. The 2025 ESC VHD Guidelines emphasise that TAVI should not be offered when: (1) life expectancy is <1 year due to non-cardiac comorbidities; (2) the probability of 'survival with benefit' (improved quality of life or functional capacity) is low; (3) the frailty burden is so severe that recovery from the procedure itself is unlikely. The Heart Team assessment should consider the patient's overall trajectory, not just the valve disease. Tools like the STS-PROM, frailty scores (CFS, Fried criteria), and geriatric assessment help identify patients unlikely to benefit. Offering a technically feasible procedure that will not improve the patient's quality or duration of life is not in the patient's interest.

Reference: ESC/EACTS (2025): VHD Guidelines