Safety of Transcatheter Aortic Valve Replacement in Patients with Aortic Aneurysm: A Propensity-Matched Analysis.
Aortic aneurysm
Aortic stenosis
Transcatheter aortic valve replacement
Journal
Cardiology and therapy
ISSN: 2193-8261
Titre abrégé: Cardiol Ther
Pays: England
ID NLM: 101634495
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
16
08
2021
accepted:
05
02
2022
pubmed:
7
3
2022
medline:
7
3
2022
entrez:
6
3
2022
Statut:
ppublish
Résumé
There is a paucity of data regarding the outcomes of transcatheter aortic valve replacement (TAVR) among patients with thoracic or abdominal aortic aneurysms (AA). Using the Nationwide Inpatient Sample (NIS) database, we explored the safety of TAVR among patients with a diagnosis of AA. We queried the National Inpatient Sample database (2012-2017) for hospitalized patients undergoing TAVR, using ICD-9 and ICD-10 codes for endovascular TAVR. Reports show that > 95% of endovascular TAVR in the US is via transfemoral access, so our population are mostly patients undergoing transfemoral TAVR. Using propensity score matching, we compared the trends and outcomes of TAVR procedures among patients with versus without AA. From a total sample of 29,517 individuals who had TAVR procedures between January 2012 and December 2017, 910 had a diagnosis of AA. In 774 matched-pair analysis, all-cause in-hospital mortality was similar in patients with and without AA OR 0.63 [(95% CI 0.28-1.43), p = 0.20]. The median length of stay was higher in patients with AA: 4 days (IQR 2.0-7.0) versus 3 days (IQR 2.0-6.0) p = 0.01. Risk of AKI [OR 1.01 (0.73-1.39), p = 0.87], heart block requiring pacemaker placement [OR 1.17 (0.81-1.69), p = 0.40], aortic dissection [OR 2.38 (0.41-13.75), p = 0.25], acute limb ischemia [OR 0.46 (0.18-1.16), p = 0.09], vascular complications [OR 0.80 (0.34-1.89), p = 0.53], post-op bleeding [OR 1.12 (0.81-1.57), p = 0.42], blood transfusion [OR 1.20 (0.84-1.70), p = 0.26], and stroke [OR 0.58 (0.24-1.39), p = 0.25] were similar in those with and without AA. Data from a large nationwide database demonstrated that patients with AA undergoing TAVR are associated with similar in-hospital outcomes compared with patients without AA.
Identifiants
pubmed: 35249199
doi: 10.1007/s40119-022-00258-6
pii: 10.1007/s40119-022-00258-6
pmc: PMC8933596
doi:
Types de publication
Journal Article
Langues
eng
Pagination
143-154Informations de copyright
© 2022. The Author(s).
Références
Strange G, Stewart S, Celermajer D, et al. Poor long-term survival in patients with moderate aortic stenosis. J Am Coll Cardiol. 2019;74(15):1851–63. https://doi.org/10.1016/j.jacc.2019.08.004 .
doi: 10.1016/j.jacc.2019.08.004
pubmed: 31491546
Di Eusanio M, Fortuna D, De Palma R, et al. Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg. 2011;141(4):940–7. https://doi.org/10.1016/j.jtcvs.2010.05.044 .
doi: 10.1016/j.jtcvs.2010.05.044
pubmed: 20599229
Matiasz R, Rigolin VH. 2017 focused update for management of patients with valvular heart disease: summary of new recommendations. J Am Heart Assoc. 2018;7(1): e007596. https://doi.org/10.1161/JAHA.117.007596 .
doi: 10.1161/JAHA.117.007596
pmcid: 5778970
Madigan M, Atoui R. Non-transfemoral access sites for transcatheter aortic valve replacement. J Thorac Dis. 2018;10(7):4505–15. https://doi.org/10.21037/jtd.2018.06.150 .
doi: 10.21037/jtd.2018.06.150
pubmed: 30174904
pmcid: 6105973
Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT registry of transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;76(21):2492–516. https://doi.org/10.1016/j.jacc.2020.09.595 .
doi: 10.1016/j.jacc.2020.09.595
pubmed: 33213729
Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography. JACC Cardiovasc Imaging. 2019;12(1):1–24. https://doi.org/10.1016/j.jcmg.2018.12.003 .
doi: 10.1016/j.jcmg.2018.12.003
pubmed: 30621986
Boudoulas KD, Wolfe B, Ravi Y, Lilly S, Nagaraja HN, Sai-Sudhakar CB. The aortic stenosis complex: aortic valve, atherosclerosis, aortopathy. J Cardiol. 2015;65(5):377–82. https://doi.org/10.1016/j.jjcc.2014.12.021 .
doi: 10.1016/j.jjcc.2014.12.021
pubmed: 25890578
Forsdahl SH, Solberg S, Singh K, Jacobsen BK. Abdominal aortic aneurysms, or a relatively large diameter of non-aneurysmal aortas, increase total and cardiovascular mortality: the Tromsø study. Int J Epidemiol. 2010;39(1):225–32. https://doi.org/10.1093/ije/dyp320 (Epub 2009 Nov 5).
doi: 10.1093/ije/dyp320
pubmed: 19897467
Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607. https://doi.org/10.1056/NEJMoa1008232 .
doi: 10.1056/NEJMoa1008232
pubmed: 20961243
Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98. https://doi.org/10.1056/NEJMoa1103510 .
doi: 10.1056/NEJMoa1103510
pubmed: 21639811
Kobayashi A, Lazkani M, Moualla S, et al. Impact of aortic aneurysms in trans-catheter aortic valve replacement: a single center experience. Indian Heart J. 2018;70(Suppl 3):S303–8. https://doi.org/10.1016/j.ihj.2018.06.022 .
doi: 10.1016/j.ihj.2018.06.022
pubmed: 30595280
pmcid: 6309288
Rylski B, Szeto WY, Bavaria JE, et al. Transcatheter aortic valve implantation in patients with ascending aortic dilatation: safety of the procedure and mid-term follow-up. Eur J Cardiothorac Surg. 2014;46(2):228–33. https://doi.org/10.1093/ejcts/ezt594 .
doi: 10.1093/ejcts/ezt594
pubmed: 24420370
Houchens RL, Ross DN, Elixhauser A, and Jiang J. Nationwide Inpatient Sample Redesign Final Report. 2014. HCUP NIS Related Reports ONLINE. April 4 2014. U.S. Agency for Healthcare Research and Quality. Available: http://www.hcupus.ahrq.gov/db/nation/nis/nisrelatedreports.jsp
Elbadawi A, Naqvi SY, Elgendy IY, Almahmoud MF, Hamed M, Abowali H, Ogunbayo GO, Jneid H, Ziada KM. Ethnic and gender disparities in the uptake of transcatheter aortic valve replacement in the United States. Cardiology and therapy. 2019;8(2):151–5.
doi: 10.1007/s40119-019-0138-1
Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol. 2014;30(9):962–70. https://doi.org/10.1016/j.cjca.2014.03.022 .
doi: 10.1016/j.cjca.2014.03.022
pubmed: 24986049
Kiani S, Stebbins A, Thourani VH, et al. The effect and relationship of frailty indices on survival after transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2020;13(2):219–31. https://doi.org/10.1016/j.jcin.2019.08.015 .
doi: 10.1016/j.jcin.2019.08.015
pubmed: 31973795
Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv. 2012;5(9):974–81. https://doi.org/10.1016/j.jcin.2012.06.011 .
doi: 10.1016/j.jcin.2012.06.011
pubmed: 22995885
pmcid: 3717525
Butala NM, Chung M, Secemsky EA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: variation in practice and outcomes. JACC Cardiovasc Interv. 2020;13(11):1277–87. https://doi.org/10.1016/j.jcin.2020.03.008 .
doi: 10.1016/j.jcin.2020.03.008
pubmed: 32499018
pmcid: 7650030
Newman AB, Arnold AM, Burke GL, O’Leary DH, Manolio TA. Cardiovascular disease and mortality in older adults with small abdominal aortic aneurysms detected by ultrasonography: the cardiovascular health study. Ann Intern Med. 2001;134(3):182–90. https://doi.org/10.7326/0003-4819-134-3-200102060-00008 .
doi: 10.7326/0003-4819-134-3-200102060-00008
pubmed: 11177330
Edwards FH, Cohen DJ, O’Brien SM, et al. Development and validation of a risk prediction model for in-hospital mortality after transcatheter aortic valve replacement. JAMA Cardiol. 2016;1(1):46–52. https://doi.org/10.1001/jamacardio.2015.0326 .
doi: 10.1001/jamacardio.2015.0326
pubmed: 27437653
van Kesteren F, van Mourik MS, Vendrik J, et al. Incidence, predictors, and impact of vascular complications after transfemoral transcatheter aortic valve implantation with the SAPIEN 3 prosthesis. Am J Cardiol. 2018;121(10):1231–8. https://doi.org/10.1016/j.amjcard.2018.01.050 .
doi: 10.1016/j.amjcard.2018.01.050
pubmed: 29703437
Barbash IM, Ben-Dor I, Dvir D, et al. Incidence and predictors of acute kidney injury after transcatheter aortic valve replacement. Am Heart J. 2012;163(6):1031–6. https://doi.org/10.1016/j.ahj.2012.01.009 .
doi: 10.1016/j.ahj.2012.01.009
pubmed: 22709757
Najjar M, Salna M, George I. Acute kidney injury after aortic valve replacement: incidence, risk factors and outcomes. Expert Rev Cardiovasc Ther. 2015;13(3):301–16. https://doi.org/10.1586/14779072.2015.1002467 .
doi: 10.1586/14779072.2015.1002467
pubmed: 25592763
Fadahunsi OO, Olowoyeye A, Ukaigwe A, et al. Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv. 2016;9(21):2189–99. https://doi.org/10.1016/j.jcin.2016.07.026 .
doi: 10.1016/j.jcin.2016.07.026
pubmed: 27832844
Nazif TM, Dizon JM, Hahn RT, et al. Predictors and clinical outcomes of permanent pacemaker implantation after transcatheter aortic valve replacement: the PARTNER (Placement of AoRtic TraNscathetER Valves) trial and registry. JACC Cardiovasc Interv. 2015;8(1 Pt A):60–9. https://doi.org/10.1016/j.jcin.2014.07.022 .
doi: 10.1016/j.jcin.2014.07.022
pubmed: 25616819
Demir OM, Iannopollo G, Mangieri A, et al. The role of cerebral embolic protection devices during transcatheter aortic valve replacement. Front Cardiovasc Med. 2018;5:150. https://doi.org/10.3389/fcvm.2018.00150 .
doi: 10.3389/fcvm.2018.00150
pubmed: 30406115
pmcid: 6205957
Behr-Rasmussen C, Grøndal N, Bramsen MB, Thomsen MD, Lindholt JS. Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study. Eur J Vasc Endovasc Surg. 2014;48(3):301–7. https://doi.org/10.1016/j.ejvs.2014.05.014 .
doi: 10.1016/j.ejvs.2014.05.014
pubmed: 24969094
Parr A, McCann M, Bradshaw B, Shahzad A, Buttner P, Golledge J. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. J Vasc Surg. 2011;53(1):28–35. https://doi.org/10.1016/j.jvs.2010.08.013 .
doi: 10.1016/j.jvs.2010.08.013
pubmed: 20934838
pmcid: 3010459
Thourani VH, O’Brien SM, Kelly JJ, et al. Development and application of a risk prediction model for in-hospital stroke after transcatheter aortic valve replacement: a report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg. 2019;107(4):1097–103. https://doi.org/10.1016/j.athoracsur.2018.11.013 .
doi: 10.1016/j.athoracsur.2018.11.013
pubmed: 30529671
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2). Eur J Cardiothorac Surg. 2012;42(5):S45–60. https://doi.org/10.1093/ejcts/ezs533 .
doi: 10.1093/ejcts/ezs533
pubmed: 23026738
Généreux P, Head SJ, Van Mieghem NM, et al. Clinical outcomes after transcatheter aortic valve replacement using valve academic research consortium definitions: a weighted meta-analysis of 3,519 patients from 16 studies. J Am Coll Cardiol. 2012;59(25):2317–26. https://doi.org/10.1016/j.jacc.2012.02.02 .
doi: 10.1016/j.jacc.2012.02.02
pubmed: 22503058
Thomas M, Schymik G, Walther T, et al. Thirty-day results of the SAPIEN aortic Bioprosthesis European Outcome (SOURCE) Registry: A European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2010;122(1):62–9. https://doi.org/10.1161/CIRCULATIONAHA.109.907402 .
doi: 10.1161/CIRCULATIONAHA.109.907402
pubmed: 20566953
Wiley JM, White CJ, Uretsky BF. Noncoronary complications of coronary intervention. Catheter Cardiovasc Interv. 2002;57(2):257–65. https://doi.org/10.1002/ccd.10307 .
doi: 10.1002/ccd.10307
pubmed: 12357533
Biancari F, D’Andrea V, Di Marco C, Savino G, Tiozzo V, Catania A. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J. 2010;159(4):518–31. https://doi.org/10.1016/j.ahj.2009.12.027 .
doi: 10.1016/j.ahj.2009.12.027
pubmed: 20362708
Tavris DR, Wang Y, Jacobs S, Gallauresi B, Curtis J, Messenger J, Resnic FS, Fitzgerald S. Bleeding and vascular complications at the femoral access site following percutaneous coronary intervention (PCI): an evaluation of hemostasis strategies. J Invasive Cardiol. 2012;24(7):328–34.
pubmed: 22781471
Piechota-Polanczyk A, Jozkowicz A, Nowak W, Eilenberg W, Neumayer C, Malinski T, Huk I, Brostjan C. The abdominal aortic aneurysm and intraluminal thrombus: current concepts of development and treatment. Front Cardiovasc Med. 2015;26(2):19. https://doi.org/10.3389/fcvm.2015.00019.PMID:26664891;PMCID:PMC4671358 .
doi: 10.3389/fcvm.2015.00019.PMID:26664891;PMCID:PMC4671358
Mangieri A, Montalto C, Poletti E, et al. Thrombotic versus bleeding risk after transcatheter aortic valve replacement: JACC review topic of the week. J Am Coll Cardiol. 2019;74(16):2088–101. https://doi.org/10.1016/j.jacc.2019.08.1032 .
doi: 10.1016/j.jacc.2019.08.1032
pubmed: 31623768
Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, Ogunbayo GO, Megaly M, Saad M, Omer MA, Paniagua D. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2019;12(18):1825–36.
doi: 10.1016/j.jcin.2019.04.039
Elbadawi A, Saad M, Elgendy IY, Barssoum K, Omer MA, Soliman A, Almahmoud MF, Ogunbayo GO, Mentias A, Gilani S, Jneid H. Temporal trends and outcomes of transcatheter versus surgical aortic valve replacement for bicuspid aortic valve stenosis. JACC Cardiovasc Interv. 2019;12(18):1811–22.
doi: 10.1016/j.jcin.2019.06.037