Autoimmune connective tissue diseases and aortic valve replacement outcomes: a population-based study

Author:

Gad Mohamed M.12ORCID,Lichtman Devora1,Saad Anas M.1,Isogai Toshiaki1,Bansal Agam1,Abdallah Mouin S.3,Roselli Eric1,Chatterjee Soumya1,Reed Grant W.1,Kapadia Samir R.1,Menon Venu1,Wassif Heba1

Affiliation:

1. Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Heart and Vascular Institute , 9500 Euclid Avenue, J2-3, Cleveland, OH 44195, USA

2. Gillings School of Global Public Health, the University of North Carolina at Chapel Hill , Chapel Hill, NC 27599, USA

3. Department of Cardiology, Medstar Heart and Vascular Institute , Fairfax, VA 22031, USA

Abstract

Abstract Aims Patients with autoimmune connective tissue diseases (CTDs) have a high burden of valvular heart disease and are often thought of as high surgical risk patients. Methods and results Patients undergoing aortic valve replacement (AVR) were identified in the Nationwide Readmissions Database between January 2012 and December 2018. Patients with a history of systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, mixed C, Sjögren syndrome, polymyositis, and dermatomyositis were included in the CTD cohort. Patients undergoing coronary artery bypass grafting concomitantly with AVR were excluded. A total of 569 600 hospitalizations were included, of which16 531 (2.9%) had CTD. CTD patients were more likely to be females, with higher rates of heart failure, pulmonary hypertension, and more likely to be insured by Medicare. CTD patients had lower mortality than non-CTD patients [odds ratio (OR) 0.66; 95% confidence interval (CI): 0.59–0.74] and stroke [OR 0.87; 95% (CI): 0.79–0.97]. CTD patients undergoing SAVR had lower mortality [OR 0.69; 95% (CI): 0.60–0.80] and stroke [OR 0.86; 95% (CI): 0.75–0.98). CTD patients undergoing TAVR had lower mortality outcomes [OR 0.67; 95% (CI): 0.56–0.80]; however, they had comparable stroke outcomes [OR 0.97; 95% (CI): 0.83–1.13, P = 0.69]. Conclusions Outcomes for patients with CTD requiring AVR are not inferior to their non-CTD counterparts. A comprehensive heart team selection of patients undergoing AVR approaches should place CTD history under consideration; however, pre-existing CTD should not be prohibitive of AVR interventions.

Publisher

Oxford University Press (OUP)

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Percutaneous closure of ruptured sinus of Valsalva: A review;Cardiovascular Revascularization Medicine;2023-09

2. Highlights from 2022 in EHJ Open;European Heart Journal Open;2022-11-01

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