Transcatheter Aortic Valve Replacement Outcomes in Patients with Chronic Inflammatory Systemic Diseases

The clinical impact of performing transcatheter aortic valve replacement (TAVR) in patients with chronic inflammatory systemic diseases (CIDs) is not well reported. Hence, we designed this study to evaluate whether coexistence of CIDs in TAVR patients leads to worse clinical outcomes. We retrospectively studied TAVR patients at our institution between 11/21/2011 and 03/29/2024. Patients diagnosed with chronic inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), scleroderma, Sjögren's syndrome, inflammatory bowel disease, or other related diseases were identified using International Classification of Diseases codes. Clinical outcomes during inpatient and at one-year were compared between CIDs and no-CID patients. Our study included 2,880 TAVR patients with mean age of 79±9 years, 45% were female, and 78% were Caucasian. CIDs patients comprised 6.4% (n=185) of the total cohort. The CIDs cohort had a higher proportion of females (61.6 vs. 43.9%, p<0.001), immunosuppressive therapy (5.9 vs. 2.9%, p=0.02), NYHA class III or IV symptoms (51.9 vs. 40%, p=0.04), and higher STS score (4.1 vs. 3.4; p=0.04). In-hospital mortality (0.0 vs. 1.7%; p=0.08) was similar between the CIDs and no-CIDs groups; however, vascular complications (10.3% vs 6.1%, p=0.036) and unplanned vascular interventions (5.4 vs. 1.9%; p=0.003) were more common in CIDs patients. Survival analysis showed no difference in one-year mortality (8.9 vs. 8.91%, log-rank p=0.73) between the two groups. In conclusion, TAVR in CIDs patients is safe and has comparable immediate and one-year adverse outcomes compared to non-CIDs patients, however these patients are more prone to vascular access complications and may require more unplanned vascular interventions.