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Impact of thoracic aortic aneurysm on outcomes of transcatheter aortic valve replacement: A nationwide cohort analysis
Author(s) -
Kassis Nicholas,
Saad Anas M.,
Ahuja Keerat Rai,
Gad Mohamed M.,
Abdelfattah Omar M.,
Isogai Toshiaki,
Shekhar Shashank,
Krishnaswamy Amar,
Svensson Lars,
Unai Shinya,
Kapadia Samir R.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29195
Subject(s) - medicine , bicuspid aortic valve , cardiac tamponade , valve replacement , cardiology , aortic dissection , stenosis , aortic valve , thoracic aortic aneurysm , aneurysm , cohort , surgery , tamponade , stroke (engine) , incidence (geometry) , aortic valve replacement , aortic aneurysm , aorta , mechanical engineering , physics , optics , engineering
Background The use of transcatheter aortic valve replacement (TAVR) has expanded to patient populations of varying surgical risk in light of recent clinical trials, yet its role in patients with aortic stenosis and coexisting thoracic aortic aneurysm (TAA) is not well‐delineated. We aimed to evaluate whether risk factors and in‐hospital outcomes vary between TAVR patients with and without an unruptured TAA. Methods The Nationwide Readmissions Database was queried for patients hospitalized between January 2012 and December 2017 who underwent TAVR with and without an unruptured TAA. In‐hospital outcomes were compared between cohorts after adjusting for sex, comorbidities, and TAVR approach, and in a subgroup analysis that excluded those with bicuspid aortic valves. Results Among 171,011 TAVR patients, 1,677 (1%) presented with TAA. Patients with TAA were younger (median age 80 vs. 82 years, p < .001) and more likely to have bicuspid aortic valves (9.3% vs. 0.9%, p < .001). Among patients with aneurysm, 2.6% died, 2.2% developed stroke, 1% developed aortic dissection, and 1.4% experienced cardiac tamponade while hospitalized. After adjusting for age, sex, bicuspid aortic valve, and all comorbidities, TAA was associated with significantly higher risk of post‐TAVR aortic dissection (OR = 2.117, 95% CI [1.304–3.435], p = .002) and cardiac tamponade (OR = 1.682, 95% CI [1.1–2.572], p = .02). Conclusions While the overall incidence of post‐TAVR complications is low, patients with an unruptured TAA should be carefully considered by the Heart Team in weighing the additional risks of aortic dissection and cardiac tamponade after TAVR with those associated with surgery.