Comparative outcomes in different aortic valve stenosis surgeries and implications of TAVR surgery for cirrhotic patients: A retrospective cohort study

Abstract

Background Our hospital system is committed to service to medically underserved, low-income, and minority populations. It is located in a city wherein 37% of people live in poverty. Overall cost effectiveness is part of our patient care quality improvement. Cirrhotic patients are at higher risk for cardiac surgery as cardiopulmonary bypass triggers the release of substances that mimic the physiologic changes seen in cirrhosis. We compared outcomes of surgeries performed for the treatment of aortic valve stenosis, surgical aortic valve replacement (SAVR), mini-surgical valve replacement (mini-SVR), and transcatheter aortic valve replacement (TAVR) with attention to cirrhotic patients. Methods This retrospective cohort study looked at the medical records of 457 patients. Demographic data, substance abuse, pre-existing diagnoses, length of stay, outcomes, and lab values were collected for each patient pre- and post-surgery. Fisher's exact test or chi square was used to compare categorical characteristics and outcomes among groups. ANOVA for repeated measures was utilized to compare group differences of continuous measurements over time. Results Despite having the highest average age of patients and higher incidence of pre-existing comorbidities, post-operative complications such as arrhythmia, hyponatremia, and coagulopathy developed to a lesser extent in TAVR patients. The length of post-surgery hospital stay was also the least in TAVR patients. TAVR offered better post-operative outcomes in cirrhotic patients as well. Conclusions TAVR showed better post-surgical outcomes and provide an option for cardiac surgery for cirrhotic patients. This data will be useful for enabling a patient-centered decision-making process in our population.

Aortic Stenosis Phenotypes and Precision Transcatheter Aortic Valve Implantation

“…After a multivariate regression model, the total hospital charges did not show a difference among patients with cirrhosis and no cirrhosis (p = 0.50) [42]. Regarding complications, data have revealed that even though some cirrhotic patients can have the highest average age and a higher incidence of pre-existing comorbidities, postoperative complications such as arrhythmia, hyponatremia, and coagulopathy developed to a lesser extent in TAVI patients [41]. Some results in cirrhotic patients undergoing TAVI might not be associated with the typical Society of Thoracic Surgeons score, but instead with the cirrhosis stage.…”

“…Most current data address how to correct this issue in retrospective cohort studies, demonstrating that TAVI has better outcomes for hospitalization, mortality, and postoperative complications than other approaches. In one study, the length of post-surgery stay at the hospital was the most minor, 6.12 (±5.59) days in TAVI patients as compared to 9.06 (±5.02) and 7.08 (±3.65) days in SAVR and mini-SVR patients, respectively [41]. Another study showed that in-hospital mortality after TAVI in patients with a history of cirrhosis compared with those without cirrhosis was not different (1.6% vs. 1.5%; p = 0.95) [42].…”