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Published on: September 9, 2020
Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the
Rohit Vyas1, Salik Nazir1, Keerat Rai Ahuja2
1Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA.
Insights
Transcatheter aortic valve replacement (TAVR) in patients with hypertrophic cardiomyopathy (HCM) is linked to higher in-hospital mortality and more procedural complications. These findings highlight increased risks for HCM patients undergoing TAVR.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Outcomes for patients with hypertrophic cardiomyopathy (HCM) undergoing transcatheter aortic valve replacement (TAVR) are not well-established.
- This study aimed to evaluate the clinical characteristics and outcomes of HCM patients post-TAVR.
Discussion:
- HCM patients undergoing TAVR exhibited higher rates of in-hospital mortality and significant procedural complications.
- These complications included acute kidney injury, bleeding, vascular issues, permanent pacemaker needs, aortic dissection, cardiogenic shock, and mechanical ventilation.
Key Insights:
- Hypertrophic cardiomyopathy patients represent a small fraction (0.38%) of TAVR recipients.
- HCM patients were more likely to be female and have comorbidities like heart failure and obesity.
- Propensity-matched analysis revealed significantly worse outcomes for HCM patients post-TAVR.
Outlook:
- Further research is needed to explore risk mitigation strategies for HCM patients undergoing TAVR.
- Developing specialized protocols may improve TAVR outcomes in this high-risk population.
- Long-term follow-up data will be crucial for understanding the full impact of TAVR on HCM patients.
Background:
Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown.
Objectives:
This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR.
Methods:
We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes.
Results:
207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement.
Conclusion:
Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.
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