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Clinical Outcomes of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Chronic Liver Disease: A

Paul Ndunda1, Sachin Srinivasan1, Mohinder Vindhyal1

  • 1Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.

Ochsner Journal
|September 19, 2019
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) may offer better outcomes for patients with chronic liver disease compared to surgical aortic valve replacement (SAVR). TAVR was associated with lower in-hospital mortality, reduced blood transfusions, and shorter hospital stays.

Area of Science:

  • Cardiology
  • Hepatology
  • Interventional Cardiology

Background:

  • Chronic liver disease significantly elevates cardiac surgical risks, with mortality rates varying widely based on disease severity (Child-Pugh class).
  • Limited data exists comparing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) outcomes specifically in patients with liver disease.

Purpose of the Study:

  • To compare the in-hospital outcomes of TAVR versus SAVR in patients suffering from chronic liver disease.
  • To evaluate differences in mortality, blood transfusion requirements, hospital length of stay, discharge disposition, acute kidney injury, and hospitalization costs between TAVR and SAVR.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Cochrane Library, Web of Science, Google Scholar).
  • Five observational studies involving 359 TAVR patients and 1,872 SAVR patients were included.
  • Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tool.

Main Results:

  • In propensity score-matched analyses, TAVR showed lower in-hospital mortality (7.3% vs 13.2%), reduced blood transfusion rates (27.4% vs 51.1%), and shorter hospital stays (10.9 vs 15.7 days) compared to SAVR.
  • No significant differences were observed between TAVR and SAVR regarding discharge home rates, acute kidney injury incidence, or mean hospitalization costs.
  • Overall analysis indicated a trend towards lower in-hospital mortality with TAVR, though not statistically significant (7.2% vs 18.1%).

Conclusions:

  • Transcatheter aortic valve replacement (TAVR) appears to be a potentially safer alternative to surgical aortic valve replacement (SAVR) for patients with chronic liver disease.
  • TAVR is associated with reduced in-hospital mortality, fewer blood transfusions, and shorter hospital stays in this high-risk patient population.
  • Further research may be warranted to confirm these findings and optimize treatment strategies for liver disease patients undergoing aortic valve replacement.

Keywords:
Aortic valve stenosiscirrhosisend stage liver diseaseheart valve diseasesliver diseasestranscatheter aortic valve replacementtreatment outcome

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