Interventions for valvular disease and heart failure

Transcatheter aortic valve replacement outcomes in patients with sarcopaenia

EuroIntervention 2019;15:671-677. DOI: 10.4244/EIJ-D-19-00110

Behnam Heidari
Behnam Heidari1, MD, MPH; Mohammed A. Al-Hijji1, MD; Michael R. Moynagh2, MB, BCh; Naoki Takahashi2, MD; Garrett Welle1, BS; Mackram Eleid1, MD; Mandeep Singh1, MD; Rajiv Gulati1, MD, PhD; Charanjit S. Rihal1, MD, MBA; Amir Lerman1, MD
1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; 2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

Aims: Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR).

Methods and results: This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality.

Conclusions: Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.

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