The clinical impact of chronic liver disease in patients undergoing transcatheter and surgical aortic valve replacement: Systematic analysis of the 2011–2017 US hospital database

Abstract

Objectives In this study, we use a national database to evaluate post‐transcatheter (TAVR)/surgical aortic valve replacement (SAVR) outcomes stratified using chronic liver disease (CLD). Background In patients undergoing TAVR and SAVR, the surgical risks should be optimized; this includes evaluating hepatic diseases that may pose an operative risk. Methods 2011–2017 National Inpatient Sample was used to select in‐hospital TAVR and SAVR cases, which were stratified according to CLD (cirrhosis, hepatitis B/C, alcoholic/fatty/nonspecific liver disease). The cases–controls were matched using propensity score matching and compared with various endpoints. Result After matching for demographics and comorbidities, for TAVR, 606 and 1818 were with or without CLD; for SAVR, 1353 and 4059 were with and without CLD. In TAVR, there was no differences in mortality (2.81% vs. 2.75% OR 1.02 95% CI 0.58–1.78) or length of stay (6.29 vs. 6.44d p = 0.29), and CLD‐present patients had marginally increased costs ($228,415 vs. $226,682 p = 0.048). There were no differences in complications. In multivariate, there was no difference in mortality (aOR 1.02 95% CI 0.58–1.79). In SAVR, CLD patients had higher mortality (7.98% vs. 3.23% OR 2.60 95% CI 2.00–3.38), length of stay (13.3 vs. 11.3 days p < 0.001), and costs ($273,487 vs. $238,097 p < 0.001). CLD patients also had increased respiratory failure (9.02% vs. 7.19% OR 1.28 95% CI 1.03–1.59) and bleeding (8.43% vs. 6.33% OR 1.36 95% CI 1.08–1.71). In multivariate, CLD had higher mortality (aOR 2.60 95% CI 2.00–3.38). Conclusion CLD is associated with higher mortality and complications in patients undergoing SAVR; however, no correlation was found in patients undergoing TAVR.

Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

“…Eight studies [ 14 – 20 ] were included in the analysis of 1–2 years mortality, all of which reported the HR value of hepatic insufficiency (compared with no hepatic insufficiency) in Cox survival analysis. Seven studies [ 21 – 27 ] were included in the short-term mortality analysis.…”

Approach to the patient with decompensated cirrhosis and aortic stenosis during liver transplantation evaluation

“…Lee et al describes no difference in mortality and complication rates in patients who undergo TAVI with or without CLD; however, it is unclear the degree of liver disease in the CLD cohort. [ 40 ] The Greason study from the Mayo Clinic compared SAVR to TAVI in patients with cirrhosis and found that the in‐hospital mortality rates in the TAVI group were significantly lower, and these patients required fewer transfusions and had shorter lengths of stay. [ 28 ] However, their study participants had a mean MELD score of 9 and STS‐PROM score of 3.2%; thus, they were overall low‐risk and did not have severe decompensated cirrhosis.…”

“…Lee et al [ 40 ] reviewed the NIS database from 2011 to 2017 for patients who underwent TAVI and SAVR with CLD, comparing case–control propensity score matching with 1353 and 4059 with and without CLD who underwent SAVR, and 606 and 1818 with and without CLD who underwent TAVI. Their study showed no difference in mortality, length of stay, or complications between patients with and without CLD.…”

Crossing the Boundaries of Treatment of Valvular Heart Disease in Patients With Liver Cirrhosis

“…RCT of patients undergoing TAVR with LC are lacking and most of the data is obtained from observational studies (15,16). Nevertheless, it seems that all data coincides that TAVR compared to surgical aortic valve replacement (SAVR) is associated to lower odds of in-hospital mortality, blood transfusions, and hospital length of stay (16).…”