Autoimmune connective tissue diseases and aortic valve replacement outcomes: a population-based study

Patients with autoimmune connective tissue diseases (CTD) have a high burden of valvular heart disease and are often thought of as high surgical risk patients. Methods Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmission Database (NRD) between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed connective tissue disease, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting (CABG) concomitantly with AVR were excluded. Results A total of 569,600 hospitalizations were included, of which,16,531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality compared to non-CTD patients (OR 0.66; 95% [CI]: 0.59-0.74); and stroke (OR 0.87; 95% [CI]: 0.79-0.97). CTD patients undergoing SAVR had lower mortality (OR 0.69; 95% [CI]: 0.60-0.80); and stroke (OR 0.86; 95% [CI]: 0.75-0.98). CTD patients undergoing TAVR had lower mortality outcomes (OR 0.67; 95% [CI]: 0.56-0.80); however, had comparable stroke outcomes (OR 0.97; 95% [CI]: 0.83-1.13, p = 0.69). Conclusions Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing aortic valve replacement approaches should put CTD history under consideration; however, pre-existing CTD should not be prohibitive of aortic valve replacement interventions.