Aortic valve replacement in patients with amyloidosis

Area of Science:

• Cardiovascular Medicine
• Cardiac Surgery
• Interventional Cardiology

Background:

• Limited outcome data exist for aortic valve replacement (AVR) in patients with amyloidosis.
• Amyloidosis, a rare disease, can affect the heart valves, necessitating intervention.
• Understanding AVR outcomes in this specific patient population is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the safety and efficacy of aortic valve replacement in patients diagnosed with amyloidosis.
• To compare outcomes between surgical AVR and transcatheter aortic valve insertion (TAVI) in this cohort.
• To assess short-term and long-term survival following AVR in patients with cardiac amyloidosis.

Main Methods:

• Retrospective review of 16 patients with amyloidosis who underwent AVR between May 2000 and February 2017.
• Procedures included surgical AVR (n=11) and transfemoral TAVI (n=5).
• Data collected included patient demographics, amyloidosis type, procedural details, and clinical outcomes.

Main Results:

• No procedure-related stroke, new-onset dialysis, pacemaker requirement, or 30-day mortality was observed.
• Transfemoral TAVI group had a significantly shorter median hospital stay (1 day) compared to surgical AVR (6 days).
• At a median follow-up of 1.9 years, four late deaths occurred, all more than one year post-surgery.

Conclusions:

• Aortic valve replacement, both surgical and transcatheter, can be performed with low operative morbidity and mortality in amyloidosis patients.
• Transcatheter aortic valve insertion demonstrates a significant advantage in reducing hospital length of stay.
• Excellent 1-year survival rates support AVR as a viable treatment option for selected patients with amyloidosis.