Complications after TAVR may occur in patients with thoracic aortic aneurysm
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Among patients who underwent transcatheter aortic valve replacement, those with thoracic aortic aneurysm had elevated risk for aortic dissection and cardiac tamponade after the procedure, researchers reported.
“While the overall incidence of post-TAVR complications is low, patients with an unruptured thoracic aortic aneurysm should be carefully considered by the heart team in weighing the additional risks of aortic dissection and cardiac tamponade after TAVR with those associated with surgery,” Nicholas Kassis, MD, resident physician at Cleveland Clinic, and colleagues wrote.
Kassis and colleagues retrospectively analyzed 171,011 patients from the Nationwide Readmissions Database who underwent TAVR from 2012 to 2017. Among the cohort, 1% had thoracic aortic aneurysm (TAA).
Compared with the others, those with TAA were younger (80 years vs. 82 years; P < .001), were more likely to be men (66% vs. 53%; P < .001) and more commonly had bicuspid aortic valves (9.3% vs. 0.9%; P < .001), according to the researchers.
Those with TAA were more likely to have aortic dissection (1% vs. 0.4%; P = .001) and cardiac tamponade (1.4% vs. 0.9%; P = .047) after the procedure than those without TAA, the researchers wrote.
After adjustment for age, sex, bicuspid aortic valve and all comorbidities, TAA was associated with elevated risk for aortic dissection (OR = 2.117; 95% CI, 1.304-3.435) and cardiac tamponade (OR = 1.682; 95% CI, 1.1-2.572), according to the researchers.
“Our novel findings further provide objective evidence that developing complications of aortic dissection and cardiac tamponade confers strikingly increased morbidity and mortality, with suboptimal rates of procedural requirements, conversions to surgery and death (22.5% and 23.7%, respectively),” Kassis and colleagues wrote. “Heightened focus on preventing these complications is therefore warranted.”
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