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Vascular complications affected outcomes after TAVR
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Vascular complications after transcatheter aortic valve replacement often lead to increased blood transfusions, greater length of hospital stay and significantly increased costs due to the need for urgent surgical or endovascular repair, researchers concluded in a case-series study.
In the study, researchers collected data on all high-risk patients (n=100) with aortic stenosis who underwent TAVR from February 2009 to April 2012 at Royal Perth Hospital, Western Australia.
Researchers defined vascular complications according to the 2011 Valve Academic Research Consortium standardized endpoints. Among the 100 patients, access approaches included 81 transfemoral, 18 transapical and one trans-subclavian. Sixty-five percent of the patients were men, and the average age was 84.9 years.
The overall 30-day mortality rate was 6%. Researchers found that the occurrence of major vascular access-related complications did not affect in-hospital or 30-day mortality rates; however, vascular complications, which occurred in 16% of patients, were found to affect perioperative management and outcomes after TAVR.
Compared with patients without vascular access-related complications, patients with vascular access-related complications, such as aortic dissection, iliac arterial rupture, femoral dissection, false aneurysms and distal embolization, experienced higher blood transfusion requirements (P=.004), greater length of hospital stay (16.4 ± 10.7 days vs. 6.5 ± 5.1 days; P=.001) and increased costs (P=.002).
“Interestingly, our multivariate analysis identified two independent predictors of vascular complication: logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) and diabetes mellitus status,” the researchers wrote, adding that both may be predictive of vascular access-related complications and should be considered during TAVR patient selection.
Disclosure: One researcher reported being a proctor for Edwards Lifesciences and Medtronic.
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