Author + information
- Jose David,
- Tafur Soto,
- Theodora Valovska,
- Laurie Ventura,
- Kristen Thornton,
- Michael Bates,
- Patrick Parrino,
- Tyrone Collins and
- Stephen Ramee
Background: Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic option to treat severe aortic stenosis in high-risk patients. Patients with cirrhosis and end-stage liver disease show high operative morbidity and mortality with cardiac surgery. The Society of Thoracic Surgeons (STS) score does not include preoperative diagnosis of cirrhosis. Data about feasibility, safety and efficacy of TAVR in cirrhosis is deficient.
Methods: A retrospective chart review was performed. All patients with clinical diagnosis of cirrhosis who underwent TAVR for severe aortic stenosis were included. Data about severity of aortic disease, comorbidities, MELD score as well as clinical and echocardiographic outcomes were obtained.
Results: 26 patients were included. The mean age was 71 years (52-92), comorbidities included: Coronary artery disease (62%), diabetes (54%), CKD (50%), COPD (38%), ESRD (8%). MELD score ranged from 6 to 24 (Med 13). All patients were evaluated by surgery and deemed high risk or inoperable. Systolic function was preserved in all. All underwent successful TAVR with either balloon or self expandable valves. 84% of implants were transfemoral and 16% transapical. A postprocedural pacemaker was required in 27%. Major bleeding was seen in 10% and hospital death in 7.6%. The median length of stay was 2 days. Heart failure readmission at 30 days was 10%. On follow up, the median improvement in NYHA class was 2 categories. There were no cases of stroke perivalvular leak at 6 months. Mortality at 12 months was 23%.
Conclusions: TAVR is a feasible therapeutic option in patients with ESLD and cirrhosis who would otherwise not qualify for surgical valve replacement. There is significant symptom improvement post TAVR, however, mortality rates in this patient population remain high.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 2
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1195-181
- 2017 American College of Cardiology Foundation