Faculty Collaboration Database

Outcomes of transcatheter aortic valve replacement in patients with chronic liver disease. Catheter Cardiovasc Interv 2015 Nov;86(5):888-94

Date

05/13/2015

Pubmed ID

25963625

DOI

10.1002/ccd.25994

Scopus ID

2-s2.0-84945474625 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

OBJECTIVE: Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to high-risk surgery in patients with comorbid conditions. The role of TAVR in patients with liver disease has not been examined.

METHODS: We examined the procedural and intermediate to long-term follow-up outcomes of patients with severe symptomatic aortic valve stenosis and chronic liver disease, identified by liver biopsy or from a combination of clinical findings. All patients were treated with balloon-expandable transfemoral (TF) or transapical (TA) TAVR between November 2007 and February 2014.

RESULTS: A total of 17 of 706 (2.41%) patients treated at our institution with TF [n=14] or TA [n=3] TAVR had chronic liver disease (mean age 77.65±9.06 years, 7 women, mean STS score 8.37, mean Charlson score 5.00, mean MELD score 11.35, Child-Turcotte-Pugh (CTP) Class A [n=11], B [n=6], C [n=0], biopsy proven liver disease [n=5]). Median follow-up was 466 days (range=12-1,403 days). The mean post-procedure length of hospital stay was 5.88±3.08 days. Procedural success was achieved in all cases. In-hospital mortality was 5.88% and 90-day mortality was 17.65%. Safety and efficacy endpoints as defined by the valve academic research consortium (VARC) were significant for one perioperative death from a proximate cardiac cause (post-operative day 14), one death after hospital discharge of unknown cause (post-operative day 12), two late deaths from non-cardiac causes (post-operative days 50 and 487, respectively), and one late death of unknown cause (post-operative day 1,005). There were no life-threatening or major bleeding complications. One patient had an MI, one had a transient ischemic attack, four had transient, Stage I, acute kidney injury and one had transient, Stage II, acute kidney injury.

CONCLUSION: TF and TA TAVR are feasible methods for treating aortic stenosis in patients with chronic liver disease. In patients with mild to moderate chronic liver disease there are acceptable rates of early and late complications, however, outcomes in patients with advanced liver disease (MELD>20 or CTP class C) warrant further study.

Author List

Shah AM, Ogbara J, Herrmann HC, Fox Z, Kadakia M, Anwaruddin S, Bavaria JE, Desai ND, Jagasia D, Szeto WY, Li RH, Vallabhajosyula P, Giri J

Author

Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Bioprosthesis
Biopsy
Cardiac Catheterization
Chronic Disease
Feasibility Studies
Female
Femoral Artery
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Hospital Mortality
Humans
Liver Diseases
Male
Middle Aged
Patient Selection
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome