Impact of TAVR on patients with severe aortic stenosis and liver cirrhosis

Abstract

We sought to assess the impact of transcatheter aortic valve replacement (TAVR) on patients that have both severe aortic stenosis (SAS) and liver cirrhosis on mortality at 365 days after index event. We identified 19,210 patients that met inclusion criteria using the TriNetX database consisting of data from 58 large healthcare organizations collected between January 1, 2010 and February 24, 2022. Of those patients, 1,283 (3.2%) had SAS with liver cirrhosis that had a TAVR, and 19,210 (96.8%) had SAS with liver cirrhosis that did not have a TAVR. We analyzed the data to compare all-cause mortality at 365 days utilizing the TriNetX web platform. Additionally, we conducted propensity score matching (PSM) to reduce the effects of confounders between the two groups. Patients with SAS and liver cirrhosis that had a TAVR were older (72.4±9.7 vs 68.0±11.8, P<0.001), and they had higher rates of heart failure (71.2% vs 34.5%, P<0.001), coronary artery disease (72.0% vs 31.2%, P<0.001), diabetes (52.5% vs 41.2%, P<0.001), and chronic kidney disease (43.8% vs 30.1%, P<0.001) compared to patients with SAS and liver cirrhosis without TAVR. PSM created two well-matched cohorts of 1,269 patients each. The TAVR group had a lower mortality rate compared to the no TAVR group (22.5% vs 34.8%, P<0.0001) at 365 days. This was confirmed using a log-rank test. Given these data, it appears that there is a mortality benefit associated with TAVR in patients with SAS and liver cirrhosis.