Transcatheter aortic valve replacement in patients with a concomitant aortic aneurysm

Abstract

Abstract Background Although there is extensive literature present on transcatheter aortic valve replacement (TAVR), there is limited data on TAVR patients with a concomitant aortic aneurysm. Purpose In this study, we investigate the short-term, in-hospital outcomes of patients undergoing TAVR with and without an aortic aneurysm. Methods This was a retrospective cohort study comparing adult patients undergoing TAVR with and without an aortic aneurysm from 2016 to 2018. We queried the National Inpatient Sample database to identify patients admitted for a principal procedure of TAVR, principal diagnosis of aortic stenosis and secondary diagnosis of aortic aneurysm. We analyzed the categorical and continuous variables by Pearson's chi-squared and Student t-test respectively. Multivariable logistic regression, adjusted for age, gender and comorbidities, was used to compare mortality. The comorbidities adjusted for included coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, obesity and type 2 diabetes mellitus. Results 109,170 patients met our inclusion criteria. Patients undergoing TAVR with an aortic aneurysm had 1.97 times higher odds of suffering in-hospital mortality compared to TAVR patients without an aortic aneurysm (aOR 1.97, 95% CI: 1.05–3.73; p=0.036). When separated by race, patients with an aortic aneurysm had higher mortality rates amongst White (3.4% vs 1.7%, p<0.001) and Hispanic (5.2% vs 2.6%, p=0.11, Figure 1) patients. TAVR patients with an aortic aneurysm were predominantly male and had higher average Charlson Comorbidity Index scores (Table 1). Furthermore, these patients also had higher rates of comorbidities such as coronary artery disease, chronic obstructive pulmonary disease and prior myocardial infarction, but decreased rates of chronic kidney disease, hypertension, obesity and type 2 diabetes mellitus (Table 1). In terms of operative complications, TAVR patients with an aortic aneurysm were more likely to have intraoperative cardiac arrest (1.1% vs 0.4%, p<0.001, Table 1). There was no significant difference between our two cohorts in postoperative cardiac arrest and postoperative cerebral infarction. Conclusion Patients undergoing TAVR with an aortic aneurysm had higher odds of suffering in-hospital mortality compared to patients undergoing TAVR without an aortic aneurysm. These patients are also at an increased risk of intraoperative cardiac arrest. Surgical intervention with a concomitant aortic aneurysm poses its own unique set of clinical challenges. Our findings emphasize the importance of risk-benefit analysis and collaborative discussion amongst the medical team prior to choosing the appropriate treatment modality. Additional studies should explore if certain races are at increased risk of operative complications and mortality. Funding Acknowledgement Type of funding sources: None.