Study Evaluates Outcomes of Patients With Liver Disease Undergoing TAVR
March 26, 2018—Chronic liver disease is a known risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery; however, there are very few data about chronic liver disease patients treated with transcatheter aortic valve replacement (TAVR). Therefore, Gabriela Tirado-Conte, MD, et al performed a study to evaluate early and late clinical outcomes in a large cohort of patients with liver disease undergoing TAVR and to determine predictive factors of mortality among these patients.
The investigators conducted a propensity score–matched analysis of clinical outcomes and prognosis markers of patients with liver disease undergoing TAVR. They published the findings in Circulation: Cardiovascular Interventions.
This multicenter study collected data from 114 patients with chronic liver disease who underwent TAVR at 12 institutions. Perioperative and long-term outcomes were compared with a cohort of 1,118 patients without liver disease after a propensity score–matching analysis (114 matched pairs).
As summarized in Circulation: Cardiovascular Interventions, the investigators reported that in-hospital mortality and vascular and bleeding complications were similar between matched groups. Acute kidney injury was more common in the liver disease group than the cohort of patients without liver disease (30.8% vs 13.5%; P = .01).
Although cardiovascular mortality was similar between groups at 2-year follow-up (9.4% vs 6.5%; P = .433), noncardiac mortality was higher in the liver disease group (26.4% vs 14.8%; P = .034).
The predictors of mortality in patients with chronic liver disease were lower glomerular filtration rate (GFR; hazard ratio [HR], 1.10 for each decrease of 5 mL/min in estimated GFR; 95% confidence interval [CI], 1.03–1.17; P = .005) and Child-Pugh class B or C (HR, 3.11; 95% CI, 1.47–6.56; P = .003); with a mortality rate of 83.2% at 2-year follow-up in patients with both factors (estimated GFR < 60 mL/min and Child-Pugh B or C).
The findings suggest that TAVR is a feasible treatment for severe aortic stenosis in patients with early stage liver disease or as bridge therapy before a curative treatment of the hepatic condition. Patients with Child-Pugh class B–C, especially in combination with renal impairment, had a very low survival rate, and TAVR should be carefully considered to avoid a futile treatment. These results may contribute to improving the clinical decision-making process and management in patients with liver disease, concluded the investigators in Circulation: Cardiovascular Interventions.