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. 2023 Sep;19(3):251-256.
doi: 10.5114/aic.2023.131478. Epub 2023 Sep 27.

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

Michał Walczewski  1 , Aleksandra Gąsecka  1 , Adam Witkowski  2 , Maciej Dabrowski  2 , Zenon Huczek  1 , Radosław Wilimski  1 , Andrzej Ochała  3 , Radosław Parma  3 , Bartosz Rymuza  1 , Marek Grygier  4 , Marek Jemielity  5 , Anna Olasińska-Wiśniewska  5 , Dariusz Jagielak  6 , Radosław Targoński  6 , Krzysztof Pastuszak  7   8   9 , Peter Grešner  8   9 , Marcin Grabowski  1 , Janusz Kochman  1
Affiliations

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

Michał Walczewski et al. Postepy Kardiol Interwencyjnej. 2023 Sep.

Abstract

Introduction: Data 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.

Aim: To 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 methods: We 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.

Results: Of 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).

Conclusions: Patients 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.

Keywords: aortic stenosis; immunosuppression; mortality; outcomes; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart TAVR – transcatheter aortic valve replacement.
Figure 2
Figure 2
Cumulative incidences of all-cause mortality among matched groups with previous immunosuppression and without it IM – immunosuppression.
See this image and copyright information in PMC

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