As transcatheter aortic valve replacement (TAVR) continues to gain momentum as a go-to treatment option for a wide range of patients with symptomatic aortic stenosis, research teams are spending more and more time evaluating its short- and long-term outcomes.
In a new meta-analysis in Current Problems in Diagnostic Cardiology, for example, an international group of specialists examined the latest data on heart failure (HF) hospitalizations following TAVR.
“Exploring the predictors of HF hospitalization is of paramount importance as it enables the identification of patients at high risk of post-TAVR complications,” wrote first author Farah Yasmin, MBBS, of Dow Medical College in Pakistan, and colleagues. “Closer detailed follow-up and enhanced treatment can improve the survival and quality of life in a patient susceptible to HF post-TAVR. Moreover, it can also reduce overall hospital readmission and associated healthcare costs.”
Yasmin et al. examined data from more than 1,000 studies for its meta-analysis, ultimately landing on eight studies after many exclusions. This left the group with data from nearly 78,000 TAVR patients. The mean age patient age was 82.1 years old, and 52.5% were men. The studies occurred in the United States, Canada, France, Japan and Spain.
Overall, five factors were found to be consistent predictors of a HF hospitalization within one year of TAVR:
- Diabetes
- Atrial fibrillation (AFib)
- Chronic kidney disease
- Chronic pulmonary disease
- A high Society of Thoracic Surgeons (STS) score
“Diabetes has been implicated as a poor prognostic factor in several procedures, including percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), and surgical aortic valve replacement (SAVR),” the authors wrote. “Plausible explanations for adverse outcomes of cardiac surgery in patients with diabetes compared with non-diabetics include increased inflammation and oxidative stress and impaired left ventricular mass regression. In the case of aortic stenosis, diabetes is linked with rapid valvular disease progression, increased hypertrophic remodeling, and decreased left ventricular systolic and diastolic function.”
AFib and chronic kidney disease, they added, have both been linked to a higher risk of heart failure in other patient populations.
“Chronic kidney disease alters the natural history of aortic stenosis, most likely by promoting the deposition of calcium on the leaflets of the aortic valve, thereby aggravating aortic stenosis and decreasing cardiac output” the authors wrote. “Reduced flow to vital organs precipitates complications after TAVR.”
Some factors the team investigated were not associated with an increased risk of post-TAVR HF hospitalizations. Those included age, a low left ventricular ejection fraction and New York Heart Association Class 3 symptoms.
To help improve TAVR outcomes—and help this procedure make an even greater impact on patient care in the years ahead—Yasmin and colleagues highlighted the importance of identifying risk factors early on, managing these conditions as well as possible before the procedure is scheduled to take place and monitoring the patient following even the most successful TAVR procedure.
“Keeping in mind the cost and expertise invested in pre- and peri-procedural care for TAVR, equal attention should be given to post-procedural outcomes,” the authors concluded. “Careful follow-up after TAVR, with closer surveillance for HF particularly, is key to preventing HF hospitalizations and death. Future research should concentrate on finding new HF predictors and assessing whether a follow-up intervention, such as the improvement of medical care, has an effect on the prognosis of this subset of patients.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.