Anticoagulation therapy lowers risk of BVD after TAVR
Sex, renal failure and atrial fibrillation (AF) are most significantly associated with mortality at 3-year follow-up, whereas anticoagulation therapy, given mostly to AF patients, reduces the risk of bioprosthetic valve dysfunction (BVD) following transcatheter aortic valve replacement (TAVR), according to a recent study.
Overall, 12,804 patients were identified in the registry between 1 January 2013 and 31 December 2015, of whom 11,469 (mean age 82.8 years; logistic European System for Cardiac Operative Risk Evaluation, 17.8 percent; mean duration of follow-up, 495 days) were alive at discharge with known antithrombotic treatment and were included in the analysis for mortality.
There were 2,555 patients who had at least two echocardiographic assessments and were eligible for BVD evaluation. Of the patients, one-third had a history of AF and had oral anticoagulation at discharge (n=3,836).
Both aspirin and clopidogrel were not associated with mortality. The strongest independent predictors of death were male sex (adjusted hazard ratio [aHR], 1.63; 95 percent CI, 1.44–1.84; p<0.001), history of AF (aHR, 1.41; 1.23–1.62; p<0.001) and chronic renal failure (aHR, 1.37; 1.23–1.53; p<0.001).
Independently, anticoagulation at discharge (adjusted odds ratio [aOR], 0.54; 0.35–0.82; p=0.005) and a nonfemoral approach (aOR, 0.53; 0.28–1.02; p=0.49) correlated with lower BVD rates, while chronic renal failure (aOR, 1.46; 1.03–2.08; p=0.034) and prosthesis size 23 mm (aOR, 3.43; 2.41–4.89; p<0.001) were associated with increased BVD risk.
This study sought to identify independent correlates of long-term all-cause mortality and early BVD, defined as increased prosthetic gradient 10 mm Hg or new gradient ≥20 mm Hg, using FRANCE TAVI (French Transcatheter Aortic Valve Implantation), a prospective, multicentre nationwide registry.
The authors performed multiple imputations to account for missing values, as well as sensitivity analysis retaining only patients with complete data.