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Erschienen in: Heart and Vessels 10/2017

23.05.2017 | Original Article

Transcatheter aortic valve implantation in patients on corticosteroid therapy

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

Erschienen in: Heart and Vessels | Ausgabe 10/2017

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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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Metadaten
Titel
Transcatheter aortic valve implantation in patients on corticosteroid therapy
verfasst von
Ryosuke Higuchi
Tetsuya Tobaru
Kenichi Hagiya
Mike Saji
Keitaro Mahara
Itaru Takamisawa
Jun Shimizu
Shuichiro Takanashi
Morimasa Takayama
Publikationsdatum
23.05.2017
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 10/2017
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-017-0996-1

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