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

Abstract

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.

Aortic Stenosis Risk in Rheumatoid Arthritis

“…After linking with CMS data to capture valvular interventions performed outside the VHA, RA was associated with an increased risk of any aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), including both SAVR (AHR, 1.30; 95% CI, 1.16-1.45) and TAVR (AHR, 1.53; 95% CI, 1.26-1.85), suggesting a more severe AS disease course that required more frequent procedural intervention. This is of particular concern since patients with RA who underwent SAVR experienced poorer postoperative outcomes in 1 study . Aggregate inpatient costs per patient undergoing SAVR or TAVR exceeded $60 000 at 6 to 12 months postoperatively …”

Early Onset Severe Aortic Stenosis Presenting with Recurrent Ventricular and Supraventricular Arrhythmia and Postoperative Stroke in a 44-year-old Man with Uncontrolled Rheumatoid Arthritis

“…Short-term follow-up also revealed risks of cardiovascular events. 10 Despite the increased risk of cardiovascular events brought by RA, there is still no consensus for treatment for patients with aortic stenosis and connective tissue disease such as RA. However, a 2021 study showed that TAVR is a viable solution even for patients with both connective tissue disease and high surgical risk.…”

“…Trials such as PARTNER 1A show that the risk of neurological events after SAVR is lower than TAVR at 2.4% and 4.3% at 30 days and 1 year, respectively. 10 However, these studies did not specifically include patients with RA, who are at higher risk of calcification and progression of aortic stenosis and therefore may have a higher risk of postoperative neurological events.…”

A Narrowing Mortality Gap: Temporal Trends of Cause‐Specific Mortality in a National Matched Cohort Study in US Veterans With Rheumatoid Arthritis

“…Although acute‐phase responses were associated with more rapid progression of aortic stenosis in an RA cohort, rates of progression were no greater than those observed among patients in previous non‐RA cohorts (32). Finally, patients with RA may have higher mortality rates following surgical aortic valve replacement (33). These novel findings of increased mortality related to valvular heart disease in RA call for clinical and epidemiologic investigations to better characterize valvular disorders in RA.…”