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Vascular complications and outcomes following transcatheter aortic valve replacement in patients on chronic steroid
Song Peng Ang1, Jia Ee Chia2, Vikash Jaiswal3
1Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA.
Insights
Chronic steroid (CS) therapy increases major vascular complications, bleeding, and annulus rupture after transcatheter aortic valve replacement (TAVR). Further research is needed to confirm these findings in TAVR patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Chronic steroid (CS) therapy is linked to vascular complications after percutaneous coronary intervention.
- The association between CS use and vascular complications post-transcatheter aortic valve replacement (TAVR) is uncertain.
Purpose of the Study:
- To compare the incidence of vascular complications and outcomes in patients undergoing TAVR with and without chronic steroid therapy.
Main Methods:
- A systematic literature search was performed in PubMed, Embase, and Cochrane databases.
- Studies were included if they reported vascular complications according to Valve Academic Research Consortium-2 definitions.
- Effect sizes were pooled using a random-effects model to calculate risk ratios (RR) with 95% confidence intervals (CI).
Main Results:
- Five studies comprising 6136 TAVR patients were analyzed.
- CS use was significantly associated with higher rates of major vascular complications (RR 2.32), major bleeding (RR 1.61), and aortic annulus rupture (RR 4.66).
- No significant differences were observed in minor vascular complications, in-hospital mortality, or 30-day mortality.
Conclusions:
- Chronic steroid therapy is associated with increased risks of major vascular complications, major bleeding, and annulus rupture following TAVR.
- Further large-scale multicenter studies or randomized controlled trials are recommended to validate these results.
Background:
Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported.
Objective:
The authors aimed to compare the rate of vascular complications and outcomes between patients with and without CS use after TAVR.
Methods:
The authors conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% CI.
Results:
Five studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the nonsteroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the nonsteroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5 vs. 6.7%, RR 2.32, 95% CI: 1.73-3.11, P <0.001), major bleeding (16.8 vs. 13.1%, RR 1.61, 95% CI: 1.27-2.05, P <0.001), and aortic annulus rupture (2.3 vs. 0.6%, RR 4.66, 95% CI: 1.67-13.01, P <0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI: 1.00-2.04, P =0.05), in-hospital mortality (2.3 vs. 1.4%, RR 1.86, 95% CI: 0.74-4.70, P =0.19), and 30-day mortality (2.9 vs. 3.1%, RR 1.14, 95% CI: 0.53-2.46, P =0.74) between both groups.
Conclusion:
Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.
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