Hypertension, Heart Rhythm Problems And Heart Failure Increase Risk of Poor Heart Valve Surgery Outcomes: Study

Certain health issues common among heart surgery patients may increase the risk of experiencing complications and adverse outcomes from transcatheter aortic valve replacement (TAVR) procedures, according to the findings of a new study.

Researchers with Tufts Medical Center in Boston say patients with high blood pressure, cardia arrhythmia and heart failure tend to suffer worse results from TAVR surgery, including a risk of rehospitalization or death within 30 days of the procedure. Their findings were published on May 7 in the Journal of the American Heart Association.

TAVR is a type of heart procedure which allows the surgeon to replace the heart valve by threading it through an artery in the leg instead of via open chest surgery. It places the valve over the damaged aortic valve in a less invasive procedure.

Initially, TAVR was approved for use only among high risk patients who were frail or couldn’t undergo open heart surgery because the surgery carried such high risks. The durability of the heart valves was also untested for use in younger patients, who need implants designed to last 30 years or more, not just 10. However, the occurrence of infections such as Staphylococcus aureus developing around the heart following TAVR procedures has raised concerns.

In this latest study, researchers sought to determine how much of an effect comorbid disease burden had on the outcomes of TAVR procedures. They conducted a retrospective single-center study of 341 patients who underwent TAVR from January 2015 to October 2018 and conducted follow-up on those patients for one year. The mean patient age was 81.4 years.

The researchers looked at 21 chronic conditions, as well as short-term and medium-term outcomes.

According to the findings, 65% of the patients have four or more chronic conditions. Researchers found that each condition increased the risk of 30-day rehospitalization and mortality by about 20%. In addition, the risk of mortality increased for those patients by nearly 30% per each additional comorbid condition.

The most common conditions reported were hypertension, which was present in more than 83% of patients; cardiac arrhythmia, which was suffered by nearly 68% of patients; and congestive heart failure, which was suffered by more than 65% of patients.

“Comorbid disease burden is associated with worse clinical outcomes in high-risk patients treated with TAVR,” the researchers concluded. “The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.”

A recent study indicated many TAVR complications could be avoided if imaging techniques, like multidetector computed topography (MDCT) were utilized. That study also found using an experienced surgeon and focusing on real-time ultrasound guidance could help prevent complications.

Some complications of TAVR include the failure of a closure device, device embolization, coronary occlusion, and higher risk of stroke.