Effect of preoperative low serum albumin on postoperative complications and early mortality in patients undergoing transcatheter aortic valve replacement

Abstract

Background: Patients undergoing transcatheter aortic valve replacement (TAVR) are mostly elderly patients with substantial comorbidities. Established risk scores are not validated for TAVR and collectives with elderly patients making periprocedural risk stratification difficult. Serum albumin is known to be an indicator for malnutrition and frailty and is simple to measure, independent of physician's bias. Using serum albumin as a preoperative marker for postoperative complications might help estimating morbidity and mortality of these patients. Methods: A total of 457 patients with severe symptomatic aortic stenosis undergoing TAVR at our institution in a period from January 2014 to December 2015 were included in this retrospective study.Baseline characteristics as well as preoperative laboratory parameters were registered. Postoperative morbidity and 30-day mortality were analyzed as primary end points. Enrolled patients with preoperative low serum albumin (<3.5 g/dL) were compared with those revealing normal serum albumin (≥3.5 g/dL). Results: Among 457 patients, 51 (11%) presented pre-procedural low serum albumin and 406 (89%) had normal serum albumin. Patients' mean age was 81±6 years and 50% of them were male. Postoperative complications such as requirement of blood transfusions (63% versus 33%, P<0.001), infection (53% versus 24%, P<0.001), acute kidney injury (41% versus 19%, P=0.001) and 30-day mortality (10% versus 3%, P=0.045) showed significant differences between preoperative low and normal albumin groups.Conclusions: Preoperative low serum albumin might be an indicator for higher morbidity and mortality in patients undergoing TAVR.

Meta-Analysis of the Impact of Pre-Procedural Serum Albumin on Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

“…After detailed evaluation of the remaining 21 full-text articles, 11 were excluded for the reasons described in Figure 1. Finally, a total 10 eligible studies [24][25][26][27][28][29][30][31][32][33] with 8,236 patents were included. Study characteristics: The baseline characteristics of the included studies and populations are listed in Table I.…”

“…Among the included studies, most (9 studies) were retrospective in design. [24][25][26][27][28][29][30][31]33) All studies included in the analysis were published within the last five years. The mean age of the enrolled patients was 83 years, and 48.8% of the patients were male.…”

“…In most of the included studies, the patient population was divided into two groups, based on pre-TAVR serum albumin levels, using a cut-off value of 3.5 g/dL. 24,25,[27][28][29]31,33) Generally, the patients were at intermediate or high surgical risk based on the values of STS-PROM score. Based on the NOS, seven studies 24,[26][27][28][29][30][31] were of high quality and three 25,32,33) were of low quality (Table II).…”

“…24,25,[27][28][29]31,33) Generally, the patients were at intermediate or high surgical risk based on the values of STS-PROM score. Based on the NOS, seven studies 24,[26][27][28][29][30][31] were of high quality and three 25,32,33) were of low quality (Table II). The impact of albumin on mortality in patients undergoing TAVR: The 30-day all-cause mortality was reported in six studies, 24,26,27,29,31,33) and the one-year, all-cause mortality was reported in all the studies, except Gassa, et al 33) (reported 30-day mortality only).…”

“…Based on the NOS, seven studies 24,[26][27][28][29][30][31] were of high quality and three 25,32,33) were of low quality (Table II). The impact of albumin on mortality in patients undergoing TAVR: The 30-day all-cause mortality was reported in six studies, 24,26,27,29,31,33) and the one-year, all-cause mortality was reported in all the studies, except Gassa, et al 33) (reported 30-day mortality only). As shown in Figure 2, a low pre-procedural albumin level was significantly associated with an approximately two-fold increase in 30-day all-cause mortality (HR, 2.09; 95% CI, 1.53-2.86) in patients undergoing TAVR.…”