Clinical Outcomes and Prognosis Markers of Patients With Liver Disease Undergoing Transcatheter Aortic Valve Replacement

Tirado‐Conte, Gabriela; Rodés‐Cabau, Josep; Rodríguez-Olivares, Ramón; Barbanti, Marco; Lhermusier, Thibault; Amat‐Santos, Ignacio J.; Toggweiler, Stefan; Cheema, Asim N.; Muñoz-García, Antonio J.; Serra, Violeta; Giordana, Francesca; Jiménez‐Quevedo, Pilar; Campelo‐Parada, Francisco; Loretz, Lucca; Todaro, Denise; Trigo, María Del; Hernández-García, José M.; Blanco, Bruno García del; Bruno, Francesco; Stella, Pieter R.; Tamburino, Corrado; Macaya, Carlos; Nombela‐Franco, Luis

doi:10.1161/circinterventions.117.005727

Cited by 40 publications

(40 citation statements)

References 42 publications

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“…(19,20) In the largest cohort to date, Tirado-Conte et al reported 1-year mortality rate of 37% after TAVR among 114 patients with chronic liver disease, 83 of whom had cirrhosis. (21) This rate is comparable to a 1-year mortality rate of 29% in our TAVR cohort. Taken together, long-term survival in our study is comparable to previous studies, with in-hospital mortality being lower in our group.…”

Section: Discussionsupporting

confidence: 76%

“…Other studies included 8 to 83 patients with cirrhosis undergoing TAVR, with the longest median follow-up being 13 months. (18)(19)(20)(21)(22) Greason et al reported no deaths at 7 months in a smaller data set from our center. (18) Wendt et al reported a 30-day mortality rate of 9.1%, (18) and Shah et al and Pascual et al reported median survival of 2.7 years.…”

Section: Discussionmentioning

confidence: 52%

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Long‐Term Outcomes After Transcatheter and Surgical Aortic Valve Replacement in Patients With Cirrhosis: A Guide for the Hepatologist

et al. 2020

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Background and Aims Hepatologists often determine whether transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) is preferred for patients with cirrhosis and severe aortic stenosis. The goal of this cohort study is to compare outcomes following TAVR and SAVR in patients with cirrhosis to inform the preferred intervention. Approach and Results Prospectively collected data on 105 consecutive patients with cirrhosis and aortic stenosis who underwent TAVR (n = 55) or SAVR (n = 50) between 2008 and 2016 were reviewed retrospectively. Two control groups were included: 2,680 patients without cirrhosis undergoing TAVR and SAVR and 17 patients with cirrhosis who received medical therapy alone. Among the 105 patients with cirrhosis, the median Society of Thoracic Surgeons score was 3.8% (1.5, 6.9), and the median Model for End‐Stage Liver Disease (MELD) score was 11.6 (9.4, 14.0). The TAVR group had similar in‐hospital (1.8% vs. 2.0%) and 30‐day mortality (3.6% vs. 4.2%) as the SAVR group. During the median follow‐up of 3.8 years (95% confidence interval, 3.0‐6.9), there were 63 (60%) deaths. MELD score (adjusted hazard ratio, 1.13; 95% confidence interval, 1.05‐1.21; P = 0.002) was an independent predictor of long‐term survival. In the subgroup of patients with MELD score <12, the TAVR group had reduced survival compared with the SAVR group (median survival of 2.8 vs. 4.4 years; P = 0.047). However, in those with MELD score ≥12, survival after TAVR, SAVR, and medical therapy was similar (1.3 vs. 2.1 vs. 1.6 years, respectively; P = 0.53). Conclusion In select patients with cirrhosis, both TAVR and SAVR have acceptable and comparable short‐term outcomes. MELD score, but not Society of Thoracic Surgeons score, independently predicts long‐term survival after TAVR and SAVR. For patients with MELD score <12, SAVR is a preferred procedure; however, neither procedure appears superior to medical therapy in patients with MELD score ≥12.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 52%

Long‐Term Outcomes After Transcatheter and Surgical Aortic Valve Replacement in Patients With Cirrhosis: A Guide for the Hepatologist

et al. 2020

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“…18,19 A study by Tirado-Conte comparing TAVR in patients with and without cirrhosis showed no difference in in-hospital and 30-day mortality, stroke, major vascular complications, bleeding complications, and new pacemaker implantation. 23 However, patients with cirrhosis had a higher rate of acute kidney injury. 23 In an analysis of the 2-year outcomes of the PARTNER (Placement of AoRTic TraNscathetER Valve) trial, the presence of liver disease was predictive of mortality in patients undergoing SAVR but not TAVR.…”

Section: Discussionmentioning

confidence: 99%

“…23 However, patients with cirrhosis had a higher rate of acute kidney injury. 23 In an analysis of the 2-year outcomes of the PARTNER (Placement of AoRTic TraNscathetER Valve) trial, the presence of liver disease was predictive of mortality in patients undergoing SAVR but not TAVR. 24 Patients with cirrhosis have pathophysiologic states that predispose them to surgical complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Chronic Liver Disease: A Systematic Review and Metaanalysis

Ndunda

Srinivasan

Vindhyal

et al. 2019

TOJ

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Background: Chronic liver disease increases cardiac surgical risk, with 30-day mortality ranging from 9% to 52% in patients with Child-Pugh class A and C, respectively. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. Methods: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant studies and assessed risk of bias using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) Cochrane Collaboration tool. Results: Five observational studies with 359 TAVR and 1,872 SAVR patients were included in the analysis. Overall, patients undergoing TAVR had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25, 1.82; I 2 =61%) than patients receiving SAVR. In propensity score-matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I 2 =13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I 2 =31%), and hospital length of stay (10.9 vs 15.7 days; mean difference-6.32; 95% CI-10.28,-2.36; I 2 =83%) than patients having SAVR. No significant differences between the 2 interventions were detected in the proportion of patients discharged home (65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I 2 =67%), acute kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I 2 = 0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized mean difference-0.07; 95% CI-0.29, 0.14; I 2 =0%). Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR.

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“…Included patients were classified into two groups: (a) without severe comorbidities and (b) with severe comorbidities and potential lack of mortality or quality of life benefit. As we previously described 20 and on the basis of results from previous studies, 21‐25 severe comorbidities were defined as the presence of any of the following criteria: severe lung disease (chronic lung disease patients who were either poorly mobile or oxygen‐dependent), severe liver disease (Model for End‐Stage Liver Disease >12), end‐stage renal disease (stage V) on dialysis treatment, severe malignancy (i.e., metastatic malignancy with life expectancy >1 year), severe dementia, severe dilated cardiomyopathy (ejection fraction <30%) and frailty. As previously described, 25 frailty status was defined as the presence of any three of the five components: a body mass index (BMI) < 20 kg/m 2 ; serum albumin <3.5 g/dl; Katz index of independence in activities of daily living score ≤ 4/6; low grip strength; and slow 15‐foot walk time.…”

Section: Methodsmentioning

confidence: 99%

Transcatheter aortic valve replacement in patients with severe comorbidities: A retrospective cohort study

Tang

Sorajja

Mooney

et al. 2020

Cathet Cardio Intervent

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Objective To investigate the long‐term outcomes of patients with severe comorbidities (sCM) undergoing transcatheter aortic valve replacement (TAVR). Background The benefit of TAVR may be limited among patients with sCM due to a lack of mortality‐ or quality‐of‐life‐benefit. Methods All TAVR patients in the Allina Health System between January 1, 2011 and August 7, 2018 were included (n = 890, 82 ± 8 years, 55% men). sCM included: severe lung disease, severe liver disease, end‐stage renal disease, severe, severe dementia, severe dilated cardiomyopathy, and frailty. Outcomes between patients with (n = 215, 24%) and without (n = 675, 76%) sCM were compared. Results At baseline, patients with sCM had worse symptoms, higher STS‐PROM and a lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score compared to those without. During a median follow‐up of 15 months (IQR, 7–29 months), there were 208 (23%) deaths. Patients with sCM had a lower 3‐year survival free from all‐cause mortality (40% vs. 79%, p < .001), and lower 3‐year survival free from the composite endpoint of all‐cause mortality, re‐hospitalization for heart failure, myocardial infarction or stroke (31% vs. 64%, p < .001) compared to those without sCM. The estimated monthly increase in KCCQ scores following TAVR was 1.5, 95%CI (1.3, 1.7), p < .001 irrespective of sCM grouping. From Cox regression analysis, severe comorbidities, with the exception of liver disease, were associated with an increased risk of all‐cause mortality and any additional comorbidity was associated with a multiplicative increase in risk of mortality of 2.8 (95%CI 2.3, 3.6), p < .001. Conclusions TAVR patients with sCM have poor 3‐year outcomes but may experience improvements in their quality of life.

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Clinical Outcomes and Prognosis Markers of Patients With Liver Disease Undergoing Transcatheter Aortic Valve Replacement

Cited by 40 publications

References 42 publications

Long‐Term Outcomes After Transcatheter and Surgical Aortic Valve Replacement in Patients With Cirrhosis: A Guide for the Hepatologist

Long‐Term Outcomes After Transcatheter and Surgical Aortic Valve Replacement in Patients With Cirrhosis: A Guide for the Hepatologist

Clinical Outcomes of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Chronic Liver Disease: A Systematic Review and Metaanalysis

Transcatheter aortic valve replacement in patients with severe comorbidities: A retrospective cohort study

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