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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
Summary
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.
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