Transcatheter aortic valve implantation in patients on corticosteroid therapy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-10

AUTHORS

Ryosuke Higuchi, Tetsuya Tobaru, Kenichi Hagiya, Mike Saji, Keitaro Mahara, Itaru Takamisawa, Jun Shimizu, Shuichiro Takanashi, Morimasa Takayama

ABSTRACT

Transcatheter aortic valve implantation (TAVI) is recommended for patients who are inoperable or at high risk for surgical aortic valve replacement (SAVR). Corticosteroid therapy is considered to be a risk factor for SAVR, but there is a paucity of information about TAVI in patients taking corticosteroids. The aim of this study is to elucidate the outcome of TAVI in patients on chronic corticosteroid therapy, compared with SAVR. We retrospectively analyzed patients on corticosteroid therapy who underwent TAVI (n = 21) or SAVR (n = 30) for severe aortic stenosis in Sakakibara Heart Institute. Primary outcome was a 30-day composite endpoint consisting of early safety endpoints (death, stroke, life-threatening bleeding, acute kidney injury, coronary obstruction, major vascular complication, and valve-related dysfunction) and corticosteroid-specific endpoints (adrenal insufficiency, sepsis, and hyperglycemic complication). There were no differences between two groups in background factors, other than patient age and serum albumin level (age 81.0 ± 5.5 vs. 74.7 ± 9.9 years, p = 0.0061, albumin 3.6 ± 0.4 vs. 4.0 ± 0.4 g/dl, p = 0.0076). Device success rate for TAVI was 95.2%. In TAVI group, operative time was shorter (100.2 ± 46.2 vs. 250.0 ± 92.2 min, p < 0.0001), and the amount of blood transfusion was less (0.67 ± 1.8 vs. 3.5 ± 2.4 units, p < 0.0001) than in SAVR group. There was no difference in primary outcome (19.0 vs. 20.0%, p = 1.0). Rate of prosthesis-patient mismatch was lower in TAVI group (4.8 vs. 33.3%, p = 0.017), and no moderate or severe post-procedural aortic regurgitation was observed in both groups. The post-procedural survival was similar in the two groups (p = 0.67, mean follow-up 986 ± 922 days). TAVI may be a viable therapeutic option in patients taking corticosteroids. More... »

PAGES

1236-1243

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-017-0996-1

DOI

http://dx.doi.org/10.1007/s00380-017-0996-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1085561318

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28536830


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43 schema:description Transcatheter aortic valve implantation (TAVI) is recommended for patients who are inoperable or at high risk for surgical aortic valve replacement (SAVR). Corticosteroid therapy is considered to be a risk factor for SAVR, but there is a paucity of information about TAVI in patients taking corticosteroids. The aim of this study is to elucidate the outcome of TAVI in patients on chronic corticosteroid therapy, compared with SAVR. We retrospectively analyzed patients on corticosteroid therapy who underwent TAVI (n = 21) or SAVR (n = 30) for severe aortic stenosis in Sakakibara Heart Institute. Primary outcome was a 30-day composite endpoint consisting of early safety endpoints (death, stroke, life-threatening bleeding, acute kidney injury, coronary obstruction, major vascular complication, and valve-related dysfunction) and corticosteroid-specific endpoints (adrenal insufficiency, sepsis, and hyperglycemic complication). There were no differences between two groups in background factors, other than patient age and serum albumin level (age 81.0 ± 5.5 vs. 74.7 ± 9.9 years, p = 0.0061, albumin 3.6 ± 0.4 vs. 4.0 ± 0.4 g/dl, p = 0.0076). Device success rate for TAVI was 95.2%. In TAVI group, operative time was shorter (100.2 ± 46.2 vs. 250.0 ± 92.2 min, p < 0.0001), and the amount of blood transfusion was less (0.67 ± 1.8 vs. 3.5 ± 2.4 units, p < 0.0001) than in SAVR group. There was no difference in primary outcome (19.0 vs. 20.0%, p = 1.0). Rate of prosthesis-patient mismatch was lower in TAVI group (4.8 vs. 33.3%, p = 0.017), and no moderate or severe post-procedural aortic regurgitation was observed in both groups. The post-procedural survival was similar in the two groups (p = 0.67, mean follow-up 986 ± 922 days). TAVI may be a viable therapeutic option in patients taking corticosteroids.
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