Outcomes After Transfemoral Transcatheter Aortic Valve Implantation With a SAPIEN 3 Valve in Patients With Cirrhosis of the Liver (a Tertiary Care Center Experience)
Section snippets
Methods
This is a single-center, retrospective, observational study approved by the Cleveland Clinic's Institutional Review Board. Informed consent was waived because it was a minimal risk study. The study population in this study comprised patients who underwent transfemoral TAVI between April 2015 and December 2018 at Cleveland Clinic. Patients with liver cirrhosis were included after confirmation of cirrhotic morphology on liver ultrasound and/or computed tomography scan of the abdomen. They were
Results
Among 1,028 patients included in the study, 32 had cirrhosis of the liver and 996 did not have cirrhosis. The baseline characteristics of the groups are mentioned in detail in Table 1. The mean age in the cirrhotic group was 74.5 years compared with 81.2 years in the noncirrhotic group. Compared with the noncirrhotic group, patients with cirrhosis had a similar rate of previous stroke (12% vs 13%, p = 1), a slightly higher rate of previous peripheral artery disease (56% vs 48%, p = 0.46), a
Discussion
The main findings of our study following 32 patients with cirrhosis who underwent TAVI are as follows:
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Incidence of bleeding after TAVI, PPM implantation, HF, stroke, MI, and aortic regurgitation were comparable between the cirrhotic and noncirrhotic groups at 30 days.
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Patients with cirrhosis undergo TAVI at a younger age than patients without cirrhosis and the outcomes are comparable with patients without cirrhosis in terms of mortality after TAVI, stroke, MI, and MACCE at 1 year.
The National
Disclosures
The authors have no conflicts of interest to disclose.
References (29)
- et al.
Clinical outcome after cardiac operations in patients with cirrhosis
Ann Thorac Surg
(2004) - et al.
Non-alcoholic fatty liver disease and increased risk of cardiovascular disease
Atherosclerosis
(2007) - et al.
Predictive risk factors for patients with cirrhosis undergoing heart surgery
Ann Thorac Surg
(2012) - et al.
Safety of cardiac surgery for patients with cirrhosis and Child-Pugh scores less than 8
Clin Gastroenterol Hepatol
(2012) - et al.
The Society of Thoracic Surgeons adult cardiac surgery risk models: part 1—background, design considerations, and model development
Ann Thorac Surg
(2018) - et al.
The Society of Thoracic Surgeons adult cardiac surgery risk models: part 2—statistical methods and results
Ann Thorac Surg
(2018) - et al.
Assessing the risk of aortic valve replacement for severe aortic stenosis in the transcatheter valve era
Mayo Clin Proc
(2014) - et al.
Contemporary reasons and clinical outcomes for patients with severe, symptomatic aortic stenosis not undergoing aortic valve replacement
Circ Cardiovasc Interv
(2018) - et al.
Transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with cirrhosis
Catheter Cardiovasc Interv
(2016) - et al.
Do patients with liver cirrhosis undergoing cardiac surgery have acceptable outcomes?
Interact Cardiovasc Thorac Surg
(2010)
Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child-Pugh score
Interact Cardiovasc Thorac Surg
Transcatheter aortic-valve replacement for inoperable severe aortic stenosis [published correction appears in N Engl J Med. 2012;367:881]
N Engl J Med
The epidemiology of cirrhosis in the United States: a population-based Study
J Clin Gastroenterol
Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 [published correction appears in Lancet. 2017;389:e1]
Lancet
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