Why the study?
Previous single-institution studies and case reports noted higher mortality and thromboembolic risks in patients with antiphospholipid syndrome undergoing aortic valve replacement, but large-scale data were lacking.
Do in-hospital outcomes differ between patients with and without antiphospholipid syndrome undergoing TAVR or SAVR?
Do in-hospital outcomes differ between patients with and without antiphospholipid syndrome undergoing TAVR or SAVR?
TAVR may be a safer alternative to SAVR for patients with antiphospholipid syndrome, as SAVR is associated with increased in-hospital risks of pulmonary embolism and acute kidney injury in this population.
Background Valvular abnormalities are common in antiphospholipid syndrome (APS). For patients who undergo aortic valve replacement (AVR), previous single institutional studies or case reports reported higher risks of mortality and thromboembolic complications among APS patients. This study aimed to investigate in-hospital outcomes of APS patients undergoing transcatheter (TAVR) and surgical aortic valve replacement (SAVR) using the largest all-payer database in the United States. Methods Patients who underwent TAVR and SAVR were selected from National Inpatient Sample from Q4 2015-2021. Exclusion criteria were age under 18 years and concomitant procedures. Preoperative characteristics were matched between APS and non-APA patients using a 1:5 propensity-score matching in TAVR and SAVR, separately. In-hospital outcomes were examined. Results After propensity-score matching, 504 non-APS patients were matched to 100 APS patients in TAVR, while 581 non-APS patients were matched to 119 APS patients in SAVR. All outcomes between APS and non-APS patients were comparable after TAVR. In contrast, APS patients undergoing SAVR had higher risks of pulmonary embolism (PE; 5.13% vs 0.86%, p < .01) and acute kidney injury (AKI; 35.04% vs 22.55%, p = .01). Conclusion This study represents one of the first large-scale, population-based analyses of AVR outcomes for APS patients using a national registry. APS patients had all comparable outcomes after TAVR, while they had higher risks of PE and AKI after SAVR. This highlights the necessity for close perioperative antithrombotic management and careful monitoring of renal function in APS patients. TAVR may offer a safer alternative to SAVR for appropriately selected patients, including those with APS.
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Li et al. (2025) studied this question.
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