Transcatheter aortic valve implantation in patients on corticosteroid therapy

Transcatheter aortic valve implantation (TAVI) is recommended for patients who are inoperable or at high risk for surgical aortic valve replacement (SAVR). Corticosteroid therapy is considered to be a risk factor for SAVR, but there is a paucity of information about TAVI in patients taking corticosteroids. The aim of this study is to elucidate the outcome of TAVI in patients on chronic corticosteroid therapy, compared with SAVR. We retrospectively analyzed patients on corticosteroid therapy who underwent TAVI (n = 21) or SAVR (n = 30) for severe aortic stenosis in Sakakibara Heart Institute. Primary outcome was a 30-day composite endpoint consisting of early safety endpoints (death, stroke, life-threatening bleeding, acute kidney injury, coronary obstruction, major vascular complication, and valve-related dysfunction) and corticosteroid-specific endpoints (adrenal insufficiency, sepsis, and hyperglycemic complication). There were no differences between two groups in background factors, other than patient age and serum albumin level (age 81.0 ± 5.5 vs. 74.7 ± 9.9 years, p = 0.0061, albumin 3.6 ± 0.4 vs. 4.0 ± 0.4 g/dl, p = 0.0076). Device success rate for TAVI was 95.2%. In TAVI group, operative time was shorter (100.2 ± 46.2 vs. 250.0 ± 92.2 min, p < 0.0001), and the amount of blood transfusion was less (0.67 ± 1.8 vs. 3.5 ± 2.4 units, p < 0.0001) than in SAVR group. There was no difference in primary outcome (19.0 vs. 20.0%, p = 1.0). Rate of prosthesis-patient mismatch was lower in TAVI group (4.8 vs. 33.3%, p = 0.017), and no moderate or severe post-procedural aortic regurgitation was observed in both groups. The post-procedural survival was similar in the two groups (p = 0.67, mean follow-up 986 ± 922 days). TAVI may be a viable therapeutic option in patients taking corticosteroids.