Long-term mortality after transcatheter aortic valve implantation for aortic stenosis in immunosuppression-treated patients: a propensity-matched multicentre retrospective registry-based analysis

• Published in: Postępy w kardiologii interwencyjnej 2023-09, Vol.19 (3), p.251-256
• Main Authors: Walczewski, Michał, Gąsecka, Aleksandra, Witkowski, Adam, Dabrowski, Maciej, Huczek, Zenon, Wilimski, Radosław, Ochała, Andrzej, Parma, Radosław, Rymuza, Bartosz, Grygier, Marek, Jemielity, Marek, Olasińska-Wiśniewska, Anna, Jagielak, Dariusz, Targoński, Radosław, Pastuszak, Krzysztof, Grešner, Peter, Grabowski, Marcin, Kochman, Janusz
• Format: Article
• Language: English
• Subjects: aortic stenosis; immunosuppression; mortality; Original Paper; outcomes; transcatheter aortic valve implantation
• ISSN: 1734-9338; 1897-4295
• DOI: 10.5114/aic.2023.131478

IntroductionData regarding patients with a previous medical record of immunosuppression treatment who have undergone transcatheter aortic valve implantation (TAVI) are limited and extremely inconclusive. Available studies are mostly short term observations; thus there is a lack of evidence on efficacy and safety of TAVI in this specific group of patients. AimTo compare the in-hospital and long-term outcomes between patients with or without a medical history of immunosuppressive treatment undergoing TAVI for aortic valve stenosis (AS). Material and methodsWe conducted a retrospective registry-based analysis including patients undergoing TAVI for AS at 5 centres between January 2009 and August 2017. The primary endpoint was long-term all-cause mortality. Secondary endpoints comprised major vascular complications, life-threatening or disabling bleeding, stroke and new pacemaker implantation. ResultsOf 1451 consecutive patients who underwent TAVI, two propensity-matched groups including 25 patients with a history of immunosuppression and 75 patients without it were analysed. No differences between groups in all-cause mortality were found in a median follow-up time of 2.7 years following TAVI (p = 0.465; HR = 0.73; 95% CI: 0.30-1.77). The rate of major vascular complications (4.0% vs. 5.3%) was similar in the two groups (p = 1.000). There were no statistically significant differences in the composite endpoint combining life-threatening or disabling bleeding, major vascular complications, stroke and new pacemaker implantation (40.0% vs. 20.0%, p = 0.218). ConclusionsPatients who had undergone TAVI for AS had similar long-term mortality regardless of whether they had a previous medical record of immunosuppression. Procedural complication rates were comparable between the groups.