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Transcatheter aortic valve implantation in patients on corticosteroid therapy

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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.

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Acknowledgements

We thank Yuko Utanohara, Kazuhiro Naito, and Nobuo Iguchi for their assistance with implementation of TAVI at out hospital.

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Authors and Affiliations

  1. Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan

    Ryosuke Higuchi, Tetsuya Tobaru, Kenichi Hagiya, Mike Saji, Keitaro Mahara, Itaru Takamisawa & Morimasa Takayama

  2. Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan

    Jun Shimizu

  3. Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan

    Shuichiro Takanashi

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  1. Ryosuke Higuchi
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  2. Tetsuya Tobaru
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  3. Kenichi Hagiya
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  4. Mike Saji
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  5. Keitaro Mahara
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  6. Itaru Takamisawa
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  7. Jun Shimizu
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  8. Shuichiro Takanashi
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  9. Morimasa Takayama
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Correspondence to Ryosuke Higuchi.

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Conflict of interest

Dr. Tobaru is proctor of Edwards Lifesciences. The other authors have no potential conflict of interest relevant to this article.

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Higuchi, R., Tobaru, T., Hagiya, K. et al. Transcatheter aortic valve implantation in patients on corticosteroid therapy. Heart Vessels 32, 1236–1243 (2017). https://doi.org/10.1007/s00380-017-0996-1

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  • DOI: https://doi.org/10.1007/s00380-017-0996-1

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