TAVR still a safe treatment option for immunocompromised patients
Transcatheter aortic valve replacement (TAVR) is both safe and effective for patients with weakened immune systems, according to a new meta-analysis published in The American Journal of Cardiology.[1]
“TAVR has transformed treatment paradigms, expanding from high-risk to intermediate- and low-risk patients, supported by robust evidence from landmark trials,” wrote first author Roel Meeus, MD, a researcher with University Hospitals Leuven in Belgium, and colleagues. “However, immunocompromised patients, often burdened by comorbidities such as malignancies or chronic inflammatory conditions, present unique challenges due to altered wound healing, dysregulated inflammation, and heightened infection risk.”
Meeus et al. tracked data from seven different studies directly comparing TAVR outcomes in patients who were and were not immunocompromised at the time of treatment. Mean ages for immunocompromised patients ranged from 78 to 81 years old. Mean ages for non-immunocompromised patients ranged from 81 to nearly 85 years old.
Overall, all-cause mortality rates were significantly higher for immunocompromised patients after two years. After just 30 days, however, all-cause mortality was comparable for immunocompromised and non-immunocompromised patients.
“The increased medium-term, all-cause mortality in immunocompromised patients in this meta-analysis underscores the increased overall vulnerability of these patients,” the authors wrote, emphasizing that immunocompromised patients are more likely to die from the “primary disease requiring immunosuppression” than any specific cardiovascular causes.
From a safety perspective, the group wrote that new permanent pacemaker implantation (PPI) and periprocedural complications were not significantly different between the two patient groups.
“We observed no difference in the need for new PPI, suggesting that immunosuppression does not significantly impact the risk of conduction system complications following TAVR,” they wrote. “This finding is in contrast with data suggesting a protective effect of glucocorticoid intake to reduce TAVR-induced mechanical trauma causing local tissue inflammation.”
Overall, Meeus and colleagues found TAVR to be both safe and effective for these vulnerable, high-risk patients. Managing these patients following treatment remains important, they concluded, and the field needs a “coordinated, multidisciplinary strategy” for providing immunocompromised patients with the care they require.
Read the full study here.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.