Association of peripheral artery disease with in‐hospital outcomes after endovascular transcatheter aortic valve replacement

Abstract

Objectives The aim of this study was to determine the prevalence of peripheral artery disease (PAD) and its association with in‐hospital outcomes after endovascular transcatheter aortic valve replacement (EV‐TAVR). Background TAVR is an established treatment for patients at prohibitive, high, or intermediate surgical risk. PAD is a significant comorbidity in the determination of surgical risk. However, data on association of PAD with outcomes after EV‐TAVR are limited. Methods Patients in the National Inpatient Sample who underwent EV‐TAVR between January 1, 2012 and September 30, 2015 were evaluated. The primary outcome was in‐hospital mortality. Results A total of 51,685 patients underwent EV‐TAVR during the study period. Of these, 12,740 (24.6%) had a coexisting diagnosis of PAD. The adjusted odds for in‐hospital mortality [OR 1.08 (95% CI 0.83–1.41)], permanent pacemaker implantation [OR 0.98 (0.85–1.14)], conversion to open aortic valve replacement [OR 1.05 (0.49–2.26)], or acute myocardial infarction [OR 1.31(0.99–1.71)] were not different in patients with versus without PAD. However, patients with PAD had greater adjusted odds of vascular complications [OR 1.80 (1.50–2.16)], major bleeding [OR 1.20 (1.09–1.34)], acute kidney injury (AKI) [OR 1.19 (1.05–1.36)], cardiac complications [aOR 1.21 (1.01–1.44)], and stroke [OR 1.39(1.10–1.75)] compared with patients without PAD. Length of stay (LOS) was significantly longer for patients with PAD [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001]. Conclusion Of patients undergoing EV‐TAVR, ~25% have coexisting PAD. PAD was not associated with increased risk of in‐hospital mortality but was associated with higher risk of vascular complications, major bleeding, AKI, stroke, cardiac complications, and longer LOS.

Development and validation of a prediction model for the prolonged length of stay in Chinese patients with lower extremity atherosclerotic disease: a retrospective study

“…The LOS in this study was similar to previous studies of PAD in China 8 10 45. But it is longer than some studies from Western countries 19 46. The research population of this study is individuals with a median age of 70 years.…”

Outcomes of Hospitalized Patients Undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) With and Without a History of Peripheral Artery Disease

“…While periprocedural outcomes in patients with cardiovascular disease have been well studied [14][15][16], there is little literature on outcomes in patients with PAD undergoing upper or lower endoscopy. Patients with PAD undergoing transcatheter aortic valve repair have been found to have an increased length of stay and increased overall cost [17]. We similarly found an increased length of stay and cost in patients with PAD undergoing ERCP, likely a result of patients with PAD having other risk factors, including smoking history, hyperlipidemia, and diabetes complicating their hospital stay [18,19].…”

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

“…Indeed, due to these interactions, several regions throughout the heart and surrounding system are often affected 118 – 120 , and certain conditions of the circulatory system may prevent the accurate assessment of C3VD or affect the outcomes of TAVR 106 . For example, from a large registry of C3VD patients undergoing endovascular TAVR, almost one quarter suffered from coexisting peripheral artery disease, which was found to be associated with higher odds of vascular complications and major bleeding 121 . Moreover, regardless of the flow conditions, the presence of hypertension or reduced arterial compliance in patients with C3VD may reduce the transvalvular gradient and peak transvalvular velocity, thus causing an underestimation of aortic stenosis severity 106 .…”