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Autoimmune connective tissue diseases and aortic valve replacement outcomes: a population-based study

Mohamed M Gad1, Devora Lichtman1, Anas M Saad1

  • 1Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute, 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA.

European Heart Journal Open
|August 3, 2022
PubMed

Insights

Patients with autoimmune connective tissue diseases (CTDs) undergoing aortic valve replacement (AVR) have comparable outcomes to non-CTD patients. CTD history should be considered but not prohibit AVR interventions for valvular heart disease.

Area of Science:

  • Cardiology
  • Rheumatology
  • Health Services Research

Background:

  • Autoimmune connective tissue diseases (CTDs) are associated with a high burden of valvular heart disease.
  • Patients with CTDs are often perceived as high surgical risk for interventions like aortic valve replacement (AVR).

Purpose of the Study:

  • To compare the outcomes of aortic valve replacement (AVR) in patients with and without connective tissue diseases (CTDs).
  • To evaluate the impact of CTD on mortality and stroke after AVR.

Main Methods:

  • Retrospective analysis of the Nationwide Readmissions Database (2012-2018).
  • Inclusion of patients undergoing AVR, with specific CTDs identified (e.g., lupus, rheumatoid arthritis, scleroderma).
  • Exclusion of patients undergoing concomitant coronary artery bypass grafting.

Main Results:

  • A total of 569,600 hospitalizations were analyzed, with 16,531 (2.9%) having CTD.
  • CTD patients were more likely female, with higher rates of heart failure and pulmonary hypertension.
  • CTD patients exhibited lower mortality (OR 0.66) and stroke (OR 0.87) rates compared to non-CTD patients post-AVR.
  • Both surgical AVR (SAVR) and transcatheter AVR (TAVR) showed lower mortality in CTD patients; stroke outcomes were comparable for TAVR.

Conclusions:

  • Outcomes for patients with CTDs undergoing AVR are not inferior to those without CTDs.
  • A history of CTD should be considered in heart team decision-making for AVR but should not preclude intervention.
  • These findings support AVR interventions for carefully selected CTD patients with valvular heart disease.
Abstract

Keywords:
Aortic valve replacementAutoimmune connective tissue diseasesValvular heart disease

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