1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Katholisches Klinikum Koblenz-Montabaur gGmbH Pneumologie Koblenz, Deutschland
Background:
To date, only a few studies have investigated patient cohorts with high-grade aortic valve stenosis (AS) and concomitant cardiac amyloidosis (CA) undergoing interventional transcatheter aortic valve replacement (TAVR).
Aims:
To assess the periprocedural management in patients undergoing TAVR depending on comorbidity of AS and CA.
Methods:
Myocardial biopsies were taken in 153 patients who underwent TAVR, in order to screen for previously unrecognized CA and to evaluate differences in periprocedural management (fluid/blood product substitution, catecholamine therapy, ICU length of stay, pacemaker implantation, delirium therapy, sedation therapy, survival). Parameters significant in the univariate analysis were included in a multivariate logistic regression analysis.
Results:
Previously unrecognized CA was found in 23 out of 153 biopsies (15.0%). Patients with CA were older (85.60 years vs. 82.61 years; p=0.0007) and had a significantly reduced survival during a mean follow-up of 200 days after TAVR (69.6% vs. 96.1% ; p=0.002). In addition, a higher rate of pacemaker implantation was observed in the CA cohort (30.4% vs. 18.5%; p=0.041). The combined endpoint (stroke, vascular access site complication, delirium, postprocedural pacemaker implantation, death) was reached significantly more often in the CA cohort (78.3% vs. 43.5%; p=0.0163). All other aspects of periprocedural management showed no significant differences between the groups.
Conclusion:
Patients undergoing TAVR with CA are older and have a reduced survival compared to patients without CA. The need for postprocedural pacemaker implantation is higher in patients with CA, while all other periprocedural aspects were not significantly different between groups. Further studies are needed to analyze the benefit of TAVR in patients with CA.