Outcomes of Transcatheter Versus Surgical Aortic Valve Implantation for Aortic Stenosis in Patients With Hepatic Cirrhosis

Alqahtani, Fahad; Aljohani, Sami; Ghabra, Anas; Alahdab, Fares; Kawsara, Akram; Holmes, David R.; Alkhouli, Mohamad

doi:10.1016/j.amjcard.2017.06.067

Cited by 21 publications

(32 citation statements)

References 13 publications

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“…Five observational studies met the eligibility criteria and were included in the systematic review and metaanalysis. 2,4,[15][16][17] Table 1 summarizes the characteristics of the included studies. These studies included a total of 2,231 patients, with 359 and 1,872 patients assigned to the TAVR and SAVR arms, respectively.…”

Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

“…Table 2 summarizes the characteristics of all patients, and Table 3 provides the characteristics of the patients in the propensity score-matched cohorts. In the 5 studies identified for this metaanalysis, bleeding events were either not reported (Dhoble et al 4 and Alqahtani et al 15 ) or the reporting was too clinically heterogeneous to be pooled. We therefore did not conduct a metaanalysis on bleeding events.…”

Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

“…16 Four studies included patients with a diagnosis of liver cirrhosis undergoing either TAVR or isolated SAVR for aortic stenosis. 2,4,15,17 The studies excluded patients <50 years of age, those with incomplete records, and patients who concomitantly underwent other cardiac procedures such as valve replacement or coronary artery bypass surgery. The study by Schill et al included patients with liver disease as defined by the STS criteria (cirrhosis, viral hepatitis, portal hypertension, alcohol dependence, or congestive hepatopathy).…”

Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

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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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Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

Section: Search Results and Patient Characteristicsmentioning

confidence: 99%

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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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“…[3][4][5]7) TAVI in patients with cirrhosis (Table IV): Although previous studies based on the national database included a comparatively large number of patients with cirrhosis, information regarding individual patient detail or mid-to long-term data following discharge remain scarce. [20][21][22] In managing a cirrhotic patient with aortic stenosis, knowledge from case series is very beneficial on clinical decision-making. [14][15][16] Greason, et al reported the outcomes of aortic valve replacement in 18 patients (TAVI in 6 cases, SAVR in 12 cases).…”

Section: )mentioning

confidence: 99%

Outcomes of Transcatheter Aortic Valve Implantation in Patients with Cirrhosis

et al. 2019

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Cirrhosis is a significant adverse factor of cardiac surgeries. Transcatheter aortic valve implantation (TAVI) has evolved as a less invasive therapy for aortic stenosis, whereas detailed case analysis of TAVI in cirrhotic patients is limited.Among 444 consecutive patients who underwent TAVI in the Sakakibara Heart Institute between October 2013 and January 2018, we retrospectively reviewed 11 patients (2.5%) with cirrhosis. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria.The median age of the patients was 82 years, and eight (73%) were female. Seven patients (64%) were Child-Turcotte-Pugh class A, and four patients (36%) were class B. The Model for End-Stage Liver Disease score was 10 (7.0-13). TAVI was performed using Edwards SAPIEN XT/SAPIEN3 in nine patients (82%), and Medtronic CoreValve/Evolut R in two patients (18%), via transfemoral (n = 8, 73%) or transapical (n = 3, 27%) approach. The device success rate was 100% and no extracorporeal circulation had been inducted. No death, stroke, life-threatening bleeding, and acute kidney injury stage 2 or 3 occurred within 30 days, but three major bleeding events (27%) were documented (two access-site bleeding in transapical approach, and one pulmonary hemorrhage caused by transient mitral regurgitation). During a median follow-up of 493 days, four deaths had occurred, and the mid-term survival rate was 81% and 65% at one and two years each.TAVI is a promising therapeutic option for patients with cirrhosis. Further study should be needed regarding optimal patient selection and procedures in patients with cirrhosis. (Int Heart J 2019; 60: 352-358)

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“…Lower in‐hospital mortality has also been reported in TAVR vs SAVR (8.2% vs 18.7%; P = .018) in cirrhotic patients. However, major adverse events were not different between the SAVR and TAVR groups …”

Section: Valvular Heart Disease and Congenital Heart Diseasementioning

confidence: 80%

Liver transplantation and cardiac illness: Current evidences and future directions

Jha

Lata

2020

J Hepato Biliary Pancreat

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Contraindications to liver transplantation are gradually narrowing. Cardiac illness and chronic liver disease may manifest independently or may be superimposed on each other due to shared pathophysiology. Cardiac surgery involving the cardiopulmonary bypass in patients with Child-Pugh Class C liver disease is associated with a high risk of perioperative morbidity and mortality. Liver transplantation involves hemodynamic perturbations, volume shifts, coagulation abnormalities, electrolyte disturbances, and hypothermia, which may prove fatal in patients with cardiac illness depending upon the severity. Additionally, cardiovascular complications are the major cause of adverse postoperative outcomes after liver transplantation even in the absence of cardiac pathologies. Clinical decision-making has remained an unsettled issue in these clinical scenarios. The absence of randomized clinical studies has further crippled our endeavours for a consensus on the management of patients with end-stage liver disease with cardiac illness. This review seeks to address this complex clinical setting by gathering information from published literature. The management algorithm in this review may facilitate clinical decision making and augur future research.

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Outcomes of Transcatheter Versus Surgical Aortic Valve Implantation for Aortic Stenosis in Patients With Hepatic Cirrhosis

Cited by 21 publications

References 13 publications

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

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

Outcomes of Transcatheter Aortic Valve Implantation in Patients with Cirrhosis

Liver transplantation and cardiac illness: Current evidences and future directions

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