Association of Autoimmune Connective Tissue Disease and Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Rudasill, Sarah; Sanaiha, Yas; Xing, Hanning; Mardock, Alexandra L.; Khoury, Habib; Jaman, Rakin; Ebrahimi, Ramin; Benharash, Peyman

doi:10.1016/j.amjcard.2019.02.023

Cited by 12 publications

(19 citation statements)

References 24 publications

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“…SLE is an autoimmune disease that affects multiple organs and systems, and is primarily characterized by dysfunctional humoral immunity, reduced CD8 + T cell cytotoxicity, defective CD4 + T cell proliferation, and impaired antigen presentation by mononuclear cells[ 5 , 6 ]. The current primary treatment for SLE includes high doses of corticosteroids and immunosuppressants.…”

Section: Discussionmentioning

confidence: 99%

Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Hu¹,

Liao²,

Zhang³

et al. 2022

WJCC

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BACKGROUND Systemic lupus erythematosus (SLE) patients are extremely susceptible to opportunistic infections due to glucocorticoid and immunosuppressive treatments, which often occur in the respiratory system, the urinary system and the skin. However, multiple cerebral infections are rarely reported and their treatment is not standardized, especially when induced by a rare pathogen. CASE SUMMARY A 46-year-old woman was treated with glucocorticoid and immunosuppressant for SLE involving the hematologic system and kidneys (class IV-G lupus nephritis) for more than one year. She was admitted to hospital due to headache and fever, and was diagnosed with multiple cerebral abscesses. Brain enhanced magnetic resonance imaging showed multiple nodular abnormal signals in both frontal lobes, left parietal and temporal lobes, left masseteric space (left temporalis and masseter region). The initial surgical plan was only to remove the large abscesses in the left parietal lobe and right frontal lobe. After surgery, based on the drug susceptibility test results (a rare pathogen Nocardia asteroides was found) and taking into consideration the patient’s renal dysfunction, a multi-antibiotic regimen was selected for the treatment. The immunosuppressant mycophenolate mofetil was discontinued on admission and the dose of prednisone was reduced from 20 mg/d to 10 mg/d. Re-examination at 3 mo post-surgery showed that the intracranial lesions were reduced, the edema around the lesions was absorbed and dissipated, and her neurological symptoms had disappeared. The patient had no headaches or other neurological symptoms and lupus nephritis was stable during the 2-year follow-up period. CONCLUSION In this report, we provide reasonable indications for immunosuppression, anti-infective therapy and individualized surgery for an SLE patient complicated with multiple cerebral abscesses caused by a rare pathogen, which may help improve the diagnosis and treatment of similar cases.

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Section: Discussionmentioning

confidence: 99%

Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Hu¹,

Liao²,

Zhang³

et al. 2022

WJCC

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“…The current evidence regarding outcomes after aortic valve replacement in patients with RA is limited. Rudasill et al studied the short-term outcomes after TAVR in patients with connective tissue diseases, resulting with a lower 30-day mortality, but the risks for post-operative infection and septicemia were increased [ 7 ]. In their cohort of 2557 patients, 75.6% had RA [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rudasill et al studied the short-term outcomes after TAVR in patients with connective tissue diseases, resulting with a lower 30-day mortality, but the risks for post-operative infection and septicemia were increased [ 7 ]. In their cohort of 2557 patients, 75.6% had RA [ 7 ]. In a report by Elbadawi et al, in-hospital mortality was studied after TAVR and SAVR in patients with RA, finding no difference between the two treatment options [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, there is currently very limited evidence regarding RA patients treated with valvular surgery and especially with aortic valve stenosis. Previous studies have indicated that RA does not increase in-hospital mortality after transapical (TAVR) or surgical aortic valve replacement (SAVR) [ 7 , 8 ], but there are no studies about the long-term results of these procedures on RA patients. Therefore, we investigated the outcomes of SAVR for aortic valve stenosis in patients with RA.…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis

Malmberg

Palomäki

Sipilä

et al. 2021

JCM

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Patients with rheumatoid arthritis (RA) have increased risk of developing cardiovascular disease and events. Little is, however, known about the influence of RA to the outcomes after surgical aortic valve replacement (SAVR). Methods: In a retrospective, nationwide, multicenter cohort study, RA patients (n = 109) were compared to patients without RA (n = 1090) treated with isolated SAVR for aortic valve stenosis. Propensity score-matching adjustment for baseline features was used to study the outcome differences in a median follow-up of 5.6 years. Results: Patients with RA had higher all-cause mortality (HR 1.76; CI 1.21–2.57; p = 0.003), higher incidence of major adverse cardiovascular events (HR 1.63; CI 1.06–2.49; p = 0.025), and they needed more often coronary artery revascularization for coronary artery disease (HR 3.96; CI 1.21–12.90; p = 0.027) in long-term follow-up after SAVR. As well, cardiovascular mortality rate was higher in patients with RA (35.7% vs. 23.4%, p = 0.023). There was no difference in 30-day mortality (2.8% vs. 1.8%, p = 0.518) or in the need for aortic valve reoperations (3.7% vs. 4.0%, p = 0.532). Conclusions: Patients with rheumatoid arthritis had impaired long-term results and increased cardiovascular mortality after SAVR for aortic valve stenosis. Special attention is needed to improve outcomes of aortic valve stenosis patients with RA after SAVR.

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“…Furthermore, data derived from a large nationwide registry demostrated that TAVI was also associated with favorable outcomes in patients with autoimmune connective tissue diseases and is comparable with AVR in terms of in‐hospital mortality in this population (Table 1). 7,8 …”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation for severe pure aortic regurgitation due to active aortitis

Ruggiero

Ponticelli

Giannini

et al. 2020

Cathet Cardio Intervent

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Aortitis is an uncommon systemic inflammatory disease affecting the aorta and its main branches. Severe aortic regurgitation (AR) represents a fearsome complication of aortitis and is associated with an increased mortality rate. Surgical aortic valve replacement represents the only treatment choice for these patients. However, it is associated with a higher risk of medium to long‐term complications such as prosthetic valve detachment. This is the first reported case where severe AR secondary to aortitis was managed with transcatheter aortic valve implantation (TAVI). TAVI was safe and effective in this clinical setting and may be considered a viable alternative to high‐risk surgery in these complex patients.

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Association of Autoimmune Connective Tissue Disease and Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Cited by 12 publications

References 24 publications

Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses: A case report

Long-Term Outcomes of Surgical Aortic Valve Replacement in Patients with Rheumatoid Arthritis

Transcatheter aortic valve implantation for severe pure aortic regurgitation due to active aortitis

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