Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement

Abstract

Background Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and comorbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. Methods and Results This was a retrospective single‐center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short‐ and medium‐term outcomes was assessed. A total of 341 patients underwent TAVR and had 1‐year follow‐up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden ( r =0.32, P <0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30‐day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30‐day rehospitalization and 30‐day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1‐year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59). Conclusions Comorbid disease burden is associated with worse clinical outcomes in high‐risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.

Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review

“…2020 50 C 4 E 5731 74 ± 10.1 38.1 — — — — — — — Feldman et al. 2021 51 C 3 L 341 81.4 ± 8 51.9 6.7 ± 4.8 — — 86.8 — — — Gracia et al. 2020 52 C 3 E 298 — — — — — — — — — Testa et al.…”

Social Deprivation and Post‐TAVR Outcomes in Ontario, Canada: A Population‐Based Study

“…Moreover, these patients may have a higher burden of comorbidity, an independent risk factor for post‐TAVR readmission and mortality. 31 , 32 …”

Editorial: Comorbidities and Aortic Valve Stenosis: Molecular Mechanism, Risk Factors and Novel Therapeutic Options

“…Given the increasing number of patients with these complex disease states, there is also an urgent need to better understand how complex co-morbidities influence the mechanism of AS initiation and progression of CAVD pathogenesis. Hypertension, type 2 diabetes mellitus, dyslipidemia, chronic kidney disease, chronic inflammatory diseases, and anemia are co-morbidities highly prevalent in AS patients (7)(8)(9)(10). The study by Roos et al identified a role for mitochondrial-derived oxidative stress in CAVD progression, suggesting a potential link between calcification processes related to metabolic shifts seen in obese or diabetic patients.…”