Yutaka Koyama1, Masanori Yamamoto2,3, Ai Kagase2, Satoshi Tsujimoto2, Seiji Kano3, Tetsuro Shimura3, Soh Hosoba3, Yusuke Watanabe4, Norio Tada5, Toru Naganuma6, Motoharu Araki7, Futoshi Yamanaka8, Kazuki Mizutani9, Minoru Tabata10, Hiroshi Ueno11, Kensuke Takagi12, Akihiro Higashimori13, Shinichi Shirai14, Kentaro Hayashida15. 1. Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan. 2. Department of Cardiology, Nagoya Heart Center, Nagoya, Japan. 3. Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. 4. Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. 5. Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan. 6. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 7. Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. 8. Department of Cardiology, Syonan Kamakura General Hospital, Kanagawa, Japan. 9. Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 10. Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan. 11. Department of Cardiology, Toyama University Hospital, Toyama, Japan. 12. Department of Cardiology, Ogaki Municipal Hospital, Japan. 13. Department of Cardiology, Kishiwada Tokushukai Hospital, Osaka, Japan. 14. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. 15. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVE: This study aimed to assess the effect of chronic steroid use on periprocedural complications and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND: Chronic steroid use increases the risk of periprocedural complications and mortality during surgery. METHODS: We investigated 1,313 consecutive patients with aortic stenosis who underwent transfemoral (TF)-TAVR using data from a Japanese multicenter registry. The baseline characteristics, periprocedural complications including vascular complications (VCs), access route related VCs, and clinical outcomes were compared between patients in the steroid group and nonsteroid group. RESULTS: Major VCs and access route VCs occurred more in the steroid group than in the nonsteroid group (13.4 vs. 5.8%, p = .019; 20.9% vs. 9.8%, p = .004). Especially in the surgical cut-down group, the rate of access route VCs was differed between the two groups (28.0% vs. 7.5%, p = .003). The 30-day mortality rates were similar between the two groups (0% vs. 1.4%, p = .39). In the propensity score-matched model, the higher incidence of major VCs in the steroid group was maintained, although early mortality was similar in the two groups. CONCLUSIONS: Although chronic steroid therapy is not associated with increased early mortality, chronic steroid use may affect periprocedural VCs and access route VCs mainly due to surgical cut-down in patients following TF-TAVR.
OBJECTIVE: This study aimed to assess the effect of chronic steroid use on periprocedural complications and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND: Chronic steroid use increases the risk of periprocedural complications and mortality during surgery. METHODS: We investigated 1,313 consecutive patients with aortic stenosis who underwent transfemoral (TF)-TAVR using data from a Japanese multicenter registry. The baseline characteristics, periprocedural complications including vascular complications (VCs), access route related VCs, and clinical outcomes were compared between patients in the steroid group and nonsteroid group. RESULTS: Major VCs and access route VCs occurred more in the steroid group than in the nonsteroid group (13.4 vs. 5.8%, p = .019; 20.9% vs. 9.8%, p = .004). Especially in the surgical cut-down group, the rate of access route VCs was differed between the two groups (28.0% vs. 7.5%, p = .003). The 30-day mortality rates were similar between the two groups (0% vs. 1.4%, p = .39). In the propensity score-matched model, the higher incidence of major VCs in the steroid group was maintained, although early mortality was similar in the two groups. CONCLUSIONS: Although chronic steroid therapy is not associated with increased early mortality, chronic steroid use may affect periprocedural VCs and access route VCs mainly due to surgical cut-down in patients following TF-TAVR.