Abstract
Background: Chronic liver disease increases cardiac surgical risk, with 30-day mortality ranging from 9% to 52% in patients with Child-Pugh class A and C, respectively. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. Methods: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant studies and assessed risk of bias using the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) Cochrane Collaboration tool. Results: Five observational studies with 359 TAVR and 1,872 SAVR patients were included in the analysis. Overall, patients undergoing TAVR had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25, 1.82; I2=61%) than patients receiving SAVR. In propensity score-matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I2=13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I2=31%), and hospital length of stay (10.9 vs 15.7 days; mean difference -6.32; 95% CI -10.28, -2.36; I2=83%) than patients having SAVR. No significant differences between the 2 interventions were detected in the proportion of patients discharged home (65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I2=67%), acute kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I2= 0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized mean difference -0.07; 95% CI -0.29, 0.14; I2=0%). Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR.
Highlights
The surgical morbidity and mortality of patients with advanced chronic liver disease undergoing heart surgery remain high,[1,2] among patients with cirrhosis Child-Pugh class B and C undergoing cardiopulmonary bypass.[1,2] The 30-day mortality risk following cardiac surgery is 9% in patients with liver cirrhosis Child-Pugh class A, 37.7% in patients with class B, and 52% in patients with class C.3 Patients with chronic liver disease have pathophysiologic changes that increase their risk of hemorrhage and organ failure
Patients undergoing transcatheter aortic valve replacement (TAVR) had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [confidence intervals (CIs)] 0.25, 1.82; I2=61%) than patients receiving surgical aortic valve replacement (SAVR)
In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR
Summary
The surgical morbidity and mortality of patients with advanced chronic liver disease undergoing heart surgery remain high,[1,2] among patients with cirrhosis Child-Pugh class B and C undergoing cardiopulmonary bypass.[1,2] The 30-day mortality risk following cardiac surgery is 9% in patients with liver cirrhosis Child-Pugh class A, 37.7% in patients with class B, and 52% in patients with class C.3 Patients with chronic liver disease have pathophysiologic changes that increase their risk of hemorrhage and organ failure. The objective of this systematic review was to compare the clinical outcomes of patients with chronic liver disease undergoing TAVR and SAVR. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. In propensity score–matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I2=13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I2=31%), and hospital length of stay (10.9 vs 15.7 days; mean difference –6.32; 95% CI –10.28, –2.36; I2=83%) than patients having SAVR. Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR
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