The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Transcatheter Aortic Valve Replacement Outcomes in Patients with Sarcopenia

EuroIntervention 2019; just accepted article published in May 2019. DOI: 10.4244/EIJ-D-19-00110

1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 3. Department of Radiology, Mayo Clinic, Rochester, Minnesota; 4. Department of Radiology, Mayo Clinic, Rochester, Minnesota; 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 6. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 7. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 8. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 9. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; 10. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, UNITED STATES
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Aims: Sarcopenia is a prevalent disease of aging, associated with adverse clinical outcomes. We compared in-hospital adverse outcomes and overall mortality in sarcopenic and non-sarcopenic patients undergoing Transcatheter Aortic Valve Replacement (TAVR).

Methods and results: This is a retrospective cohort study including 602 patients who underwent TAVR. Sarcopenia 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 sarcopenic. In-hospital outcomes were similar in both groups, but overall survival was worse in sarcopenic patients (HR for mortality= 1.46 (1.06-2.14), P=0.02). In multivariable model, sarcopenia, 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: Sarcopenic patients had similar in-hospital clinical outcomes as non-sarcopenic patients following TAVR which reveals TAVR safety in sarcopenic patients. However, sarcopenia was an independent risk factor for mid-term mortality proposing for its potential value in systematic evaluation of this highly comorbid population to decide the best treatment approaches.

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