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Chronic Limb-Threatening Ischemia Is Associated With Higher Mortality and Limb Revascularization After Transcatheter

Khanjan B Shah1, Mohammed Elzeneini1, Dan Neal2

  • 1Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.

The American Journal of Cardiology
|September 25, 2023
PubMed

Insights

Patients with chronic limb-threatening ischemia (CLTI) undergoing transcatheter aortic valve replacement (TAVR) face higher mortality and complication risks. However, overall adverse event rates remain low, suggesting TAVR is a viable option for select CLTI patients.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Peripheral arterial disease (PAD) is prevalent in patients with symptomatic aortic stenosis.
  • Chronic limb-threatening ischemia (CLTI), the most severe PAD form, significantly increases limb loss and mortality risks.
  • Transcatheter aortic valve replacement (TAVR) is a common treatment for aortic stenosis, but its outcomes in patients with CLTI require further investigation.

Purpose of the Study:

  • To determine patient characteristics and clinical outcomes of TAVR procedures in patients with and without CLTI.
  • To assess the association between CLTI and in-hospital mortality, major complications, and revascularization rates post-TAVR.

Main Methods:

  • Retrospective analysis of hospitalizations for TAVR from October 2015 to December 2018 using the National Inpatient Sample database.
  • Identification of patients with CLTI using International Classification of Diseases 10th Revision codes.
  • Comparison of in-hospital mortality, major complications, open revascularization, and endovascular revascularization between TAVR patients with and without CLTI.

Main Results:

  • A total of 31,335 TAVR hospitalizations were analyzed, with 7,048 (22.5%) involving patients with CLTI.
  • CLTI was significantly associated with higher in-hospital mortality (OR 1.4) and major complications (OR 1.2).
  • Patients with CLTI had substantially higher rates of open (OR 5.1) and endovascular (OR 4.0) limb revascularization post-TAVR.

Conclusions:

  • CLTI in TAVR patients is linked to increased in-hospital mortality, major complications, and longer hospital stays.
  • Despite these associations, the overall incidence of adverse events in this cohort remains low.
  • Optimizing multidisciplinary care and shared decision-making is crucial for managing TAVR patients with CLTI.

Keywords:
CLTIPADTAVR

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