The Real Impact of Peripheral Artery Disease in TAVR

Courtesy of Dr. Carlos Fava.

The real incidence of peripheral artery (PAD) disease in TAVR remains unclear. Different reports still estimate it is between 10 and 46%, but they have shown it has a negative impact in evolution.

Protrusión de placa en angioplastia carotidea ¿Qué riesgo implica y cómo prevenirlo?

51,685 TAVR patients were analyzed. 12,740 of these patients presented PAD (24.6%).

PAD patients tended to be younger, mostly men, smokers, hypertensive, with a history of cardiovascular and carotid disease, chronic obstructive pulmonary disease (COPD), kidney function deterioration and cardiovascular revascularization. There were no differences in obesity and diabetes. In this group, TAVR was done more often in university hospitals.


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At hospital level, there were no differences in mortality, need for pacemaker, acute myocardial infarction (AMI), or conversion to surgery. But the presence of PAD was associated to vascular complications [8.6 vs. 5.3%, OR 1.80 (1.50–2.16), p < 0.001], major bleeding [10.8 vs. 8.8%, OR 1.20 (1.09–1.34), p < 0.001], kidney function deterioration [18.2 vs. 15.6%, OR 1.19 (1.05–1.36), p=0.007], cardiac complications [9.4 vs. 8.2%, OR 1.21 (1.01–1.44), p=0.03], stroke [3.2 vs. 2.7%, OR 1.39(1.10–1.75), p=0.005] and longer in-hospital stay [7.23 (0.14) days vs. 7.11 (0.1) days, p < 0.001].

Conclusion

The presence of PAD in TAVR is 25% approximately. This disease was not associated to increased in-hospital mortality, but it was associated to higher risk of vascular complications, major bleeding, kidney function deterioration, stroke, cardiac complications and longer in-hospital stay.

Courtesy of Dr. Carlos Fava.


Original title: Association of peripheral artery disease with in-hospital outcomes after endovascular transcatheter aortic valve replacement.

Reference; Divyanshu Mohananey, et, al. Catheter Cardiovasc Interv 2019;94:249-255.


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