Transcatheter aortic valve replacement in patients with severe comorbidities: A retrospective cohort study

Abstract

Objective To investigate the long‐term outcomes of patients with severe comorbidities (sCM) undergoing transcatheter aortic valve replacement (TAVR). Background The benefit of TAVR may be limited among patients with sCM due to a lack of mortality‐ or quality‐of‐life‐benefit. Methods All TAVR patients in the Allina Health System between January 1, 2011 and August 7, 2018 were included (n = 890, 82 ± 8 years, 55% men). sCM included: severe lung disease, severe liver disease, end‐stage renal disease, severe, severe dementia, severe dilated cardiomyopathy, and frailty. Outcomes between patients with (n = 215, 24%) and without (n = 675, 76%) sCM were compared. Results At baseline, patients with sCM had worse symptoms, higher STS‐PROM and a lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score compared to those without. During a median follow‐up of 15 months (IQR, 7–29 months), there were 208 (23%) deaths. Patients with sCM had a lower 3‐year survival free from all‐cause mortality (40% vs. 79%, p < .001), and lower 3‐year survival free from the composite endpoint of all‐cause mortality, re‐hospitalization for heart failure, myocardial infarction or stroke (31% vs. 64%, p < .001) compared to those without sCM. The estimated monthly increase in KCCQ scores following TAVR was 1.5, 95%CI (1.3, 1.7), p < .001 irrespective of sCM grouping. From Cox regression analysis, severe comorbidities, with the exception of liver disease, were associated with an increased risk of all‐cause mortality and any additional comorbidity was associated with a multiplicative increase in risk of mortality of 2.8 (95%CI 2.3, 3.6), p < .001. Conclusions TAVR patients with sCM have poor 3‐year outcomes but may experience improvements in their quality of life.

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

“…Elderly patients benefit from this procedure mainly due to reduced complications compared to SAVR, multiple coexisting comorbidities, and their frail state. Findings from our study showed that the mean age from STEROID and NOSTEROID groups was over 78 years, consistent with other studies that revealed that TAVR is often carried out in elderly patients [11][12][13][14][15]. The use of chronic corticosteroid therapy is not uncommon in this set of patients due to the presence of comorbidities (e.g., rheumatoid arthritis, interstitial pneumonia, autoimmune hepatitis, polymyalgia rheumatica, systemic lupus erythematosus, multiple myositis, scleroderma) [6] which requires the use of this medication.…”