Determinants of prolonged hospitalization in patients who underwent trans-femoral transcatheter aortic valve implantation

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) has grown to be an alternative treatment for severe symptomatic aortic valve stenosis (AS) in elderly patients. Although TAVI is a less invasive surgery than surgical aortic valve replacement, some patients may require prolonged hospitalization. Aim: To find the determinants of prolonged hospitalization in patients who underwent trans-femoral TAVI. Material and methods: A total of 94 AS patients who underwent trans-femoral TAVI were included as the final study population, and divided into the conventional hospitalization group (≤ 21 days) (n = 74) and prolonged hospitalization group (> 21 days) (n = 20). We compared clinical characteristics between the two groups, and multivariate logistic regression analysis was performed to find the determinants of prolonged hospitalization. Results: In multivariate logistic regression analysis, moderate or severe mitral regurgitation (OR = 4.49, 95% CI: 1.16-17.47, p = 0.03), taking statins or angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB) on admission (statins: OR = 0.13, 95% CI: 0.02-0.71, p = 0.02, ACE inhibitors/ARB: OR = 0.25, 95% CI: 0.06-0.96, p = 0.04), estimated glomerular filtration rate (eGFR) (per 15 ml/min/1.73 m 2 incremental) (OR = 0.49, 95% CI: 0.26-0.90, p = 0.02) and current chopsticks user (OR = 0.05, 95% CI: 0.01-0.41, p < 0.01) were significantly associated with prolonged hospitalization. Conclusions: Moderate or severe mitral regurgitation was significantly associated with prolonged hospitalization, while current chopsticks user, eGFR (per 15 ml/min/1.73 m 2 incremental), taking ACE inhibitors/ARB or statins before the procedure were inversely associated with prolonged hospitalization in patients who underwent trans-femoral TAVI.

Comparison of long-term outcomes after trans-catheter aortic valve implantation between patients primarily diagnosed by cardiac murmur and those diagnosed by other reasons

“…In our medical center, 80.6% of TAVI were performed by trans-femoral approach (TF). TF-TAVI in our medical center was described in elsewhere [ 9 , 13 ]. In addition, 16.1% of TAVI were performed by trans-apical approach (TA), and other cases were by trans-iliac, direct aorta or trans subclavian approaches (3.3%).…”

The role of external iliac artery diameter indexed to BSA score in predicting vascular access complications after transfemoral transcatheter aortic valve implantation

“…On the other hand, the technical improvements, including reduction of the dimensions of delivery systems, reduced the rate of vascular complications and improved procedural outcomes. However, in the elderly population presenting with comorbidities, including peripheral artery disease and frailty, the iliofemoral arteries are often borderline acceptable for TF access [ 6 , 7 ]. The degree of vessel tortuosity, vascular calcification and atherosclerotic plaques increase with age and increase the risk of peri-procedural complications.…”