TAVI Safe and Effective in Patients With Inflammatory Bowel Disease

By Reuters Staff

July 19, 2021

NEW YORK (Reuters Health) - Transcatheter aortic-valve implantation (TAVI) is safe and effective for patients with inflammatory bowel disease (IBD), according to what is believed to be the first study to assess TAVI outcomes in this patient population.

Over the past decade, TAVI has "revolutionized" the treatment of patients with severe aortic stenosis, researchers from Cleveland Clinic, in Ohio, note in the American Journal of Cardiology.

Using the National Inpatient Sample, Dr. Samir Kapadia and colleagues identified more than 90,000 patients who underwent TAVI between 2016 and 2017, including 435 (0.48%) with IBD.

There were no significant between-group differences in co-morbidities including congestive heart failure, diabetes, hypertension, carotid-artery disease, peripheral vascular disease, chronic kidney disease, chronic dialysis, atrial fibrillation, and cardiogenic shock.

There were also no significant differences in in-hospital outcomes between patients with and without IBD, including in-hospital death (2.29% vs. 1.64%; P=0.354), stroke (2.07% vs. 1.97%; P=0.752), acute kidney injury (AKI, 10.34% vs. 11.39%; P=0.540), sepsis (1.15% vs. 0.93%; P=0.824); need for mechanical ventilation (2.29% vs. 2.88%; P=0.560;) and new pacemaker insertion (8.04% vs. 8.54%; P=0.777).

Median length of stay and hospitalization charges were also similar between groups.

"The findings in our study are important with similar stroke rates in the two groups though IBD is linked to arterial embolism, similar sepsis rates though IBD patients have increased bacteremia due to increased transmucosal permeability and prolonged corticosteroids use and similar AKI rates though IBD is associated with nephrolithiasis and glomerulonephritis," Dr. Kapadia and colleagues say.

"This points to the fact that patients who underwent TAVI are carefully selected by the heart team. Similarly in patients with coronary artery disease, the outcomes are similar in IBD vs non-IBD patients after percutaneous coronary intervention," they point out.

The main limitation of the study surrounds use of the National Inpatient Sample, with variation in data collection and the use of ICD codes which rely on fidelity of hospital billing data.

The team was also unable to determine whether a patient was having IBD flare or not and type of treatment (steroids, total parenteral nutrition, biologics, etc.) patients were receiving.

Despite these limitations, results of this nationwide cohort study show that TAVI is safe and effective in patients with IBD, they conclude.

SOURCE: https://bit.ly/3ySUNip American Journal of Cardiology, online July 6, 2021.