Impact of Long-Term Steroid Use on the Disposition of Patients Undergoing Transcatheter Aortic Valve Replacement: A Retrospective Nationwide Sample Analysis

Evbayekha, Endurance O; Alugba, Gabriel; Akewe, Theresa O; Obadare, Oyindamola  O; Agberien, Vanessa O; Omogunwa, Adebola E; Willie, Anthony; Nwafor, Jane N; Okafor, Adetoro; Okobi, Okelue E

doi:10.7759/cureus.38048

Cited by 1 publication

(1 citation statement)

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“…In addition, there was no significant difference in terms of in-hospital mortality between both groups of patients, a finding that was similar to a recently published nationwide analysis by Evbayekha et al . 20 .…”

Section: Discussionmentioning

confidence: 99%

Vascular Complications and Outcomes Following Transcatheter Aortic Valve Replacement in Patients on Chronic Steroid Therapy. A meta-analysis

Ang,

Chia,

Jaiswal

et al. 2024

International Journal of Surgery

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Background: Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. Objective: We aimed to compare the rate of vascular complications and outcomes between patients with and without (CS) use after TAVR. Methods: We conducted a comprehensive literature search in PubMed, Embase and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% confidence intervals (CI). Results: 5 studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the non-steroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the non-steroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5% vs. 6.7%, RR 2.32, 95% CI 1.73-3.11, P<0.001), major bleeding (16.8% vs. 13.1%, RR 1.61, 95% CI 1.27-2.05, P<0.001), and aortic annulus rupture (2.3% vs. 0.6%, RR 4.66, 95% CI 1.67-13.01, P<0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI 1.00-2.04, P=0.05), in-hospital mortality (2.3% vs. 1.4%, RR 1.86, 95% CI 0.74-4.70, P=0.19), and 30-day mortality (2.9% vs. 3.1%, RR 1.14, 95% CI 0.53-2.46, P=0.74) between both groups. Conclusion: Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.

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Section: Discussionmentioning

confidence: 99%