Fulltext

Vascular complications and outcomes following transcatheter aortic valve replacement in patients on chronic steroid therapy: a meta-analysis

Ang SP 1 , Chia JE 2 , Jaiswal V 3 , Hanif M 4 , Vadhera A 5 , Gautam S 6 Show all authors , Raut A 7 , Rafaqat S 8 , Borra VR 9 , Khandait H 10 , Shrestha AB 11 , Iglesias J 12

Affiliations 

  • 1 Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA
  • 2 Department of Medicine, International Medical University, Malaysia
  • 3 JCCR Cardiology Research, Varanasi, India
  • 4 Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
  • 5 Department of Medicine, Maulana Azad Medical College, New Delhi, India
  • 6 Department of Internal Medicine, Maimonides Medical Center, Brooklyn NY, USA
  • 7 Department of Internal Medicine, Nepal Medical College, Nepal
  • 8 Department of Zoology (Molecular Physiology), Lahore College for Women University, Lahore, Pakistan
  • 9 Department of Internal Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
  • 10 Department of Internal Medicine, Trinitas Regional Medical Center/RWJ Barnabas Health, Elizabeth, NJ, USA
  • 11 Department of Internal Medicine, M Abdur Rahim Medical College, Dinajpur, Bangladesh
  • 12 Department of Critical Care, Rutgers Health/Community Medical Center, Toms River, NJ, USA
Int J Surg, 2024 Apr 01;110(4):2421-2429.
PMID: 38320107 DOI: 10.1097/JS9.0000000000001132

Abstract

BACKGROUND: Chronic steroid (CS) therapy was reportedly linked to increased vascular complications following percutaneous coronary intervention. However, its association with vascular complications after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported.

OBJECTIVE: The authors aimed to compare the rate of vascular complications and outcomes between patients with and without CS use after TAVR.

METHODS: The authors conducted a comprehensive literature search in PubMed, Embase, and Cochrane databases from their inception until 18th April 2022 for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions. Effect sizes were pooled using DerSimonian and Laird random-effects model as risk ratio (RR) with 95% CI.

RESULTS: Five studies with 6136 patients undergoing TAVR were included in the analysis. The included studies were published between 2015 and 2022. The mean ages of patients in both study groups were similar, with the CS group averaging 80 years and the nonsteroid group averaging 82 years. Notably, a higher proportion of patients in the CS group were female (56%) compared to the nonsteroid group (54%). CS use was associated with a significantly higher risk of major vascular complications (12.5 vs. 6.7%, RR 2.32, 95% CI: 1.73-3.11, P <0.001), major bleeding (16.8 vs. 13.1%, RR 1.61, 95% CI: 1.27-2.05, P <0.001), and aortic annulus rupture (2.3 vs. 0.6%, RR 4.66, 95% CI: 1.67-13.01, P <0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI: 1.00-2.04, P =0.05), in-hospital mortality (2.3 vs. 1.4%, RR 1.86, 95% CI: 0.74-4.70, P =0.19), and 30-day mortality (2.9 vs. 3.1%, RR 1.14, 95% CI: 0.53-2.46, P =0.74) between both groups.

CONCLUSION: Our study showed that CS therapy is associated with increased major vascular complications, major bleeding, and annulus rupture following TAVR. Further large multicenter studies or randomized controlled trials are warranted to validate these findings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

MeSH terms
Similar publications