Background: Chronic liver disease is a known risk factor for perioperative morbidity and mortality in patients undergoing cardiac surgery. Very little data exist about such patients treated with transcatheter aortic valve replacement (TAVR). Our objective was to evaluate early and late clinical outcomes in a large cohort of patients with liver disease undergoing TAVR and to determine predictive factors of mortality among these patients.
Methods And Results: This multicenter study collected data from 114 patients with chronic liver disease who underwent TAVR in 12 institutions. Perioperative and long-term outcomes were compared with a cohort of 1118 patients without liver disease after a propensity score-matching analysis (114 matched pairs). In-hospital mortality and vascular and bleeding complications were similar between matched groups. Acute kidney injury was more common in liver disease group (30.8% versus 13.5%; =0.010). Although cardiovascular mortality was similar between groups (9.4% versus 6.5%; =0.433) at 2-year follow-up, noncardiac mortality was higher in the liver group (26.4% versus 14.8%; =0.034). Lower glomerular filtration rate (hazard ratio, 1.10, for each decrease of 5 mL/min in estimated glomerular filtration rate; 95% confidence interval, 1.03-1.17; =0.005) and Child-Pugh class B or C (hazard ratio, 3.11; 95% confidence interval, 1.47-6.56; =0.003) were the predictors of mortality in patients with chronic liver disease, with a mortality rate of 83.2% at 2-year follow-up in patients with both factors (estimated glomerular filtration rate <60 mL/min and Child-Pugh B or C).
Conclusions: These findings suggested that TAVR is a feasible treatment for severe aortic stenosis in patients with early-stage liver disease or as bridge therapy before a curative treatment of the hepatic condition. Patients with Child-Pugh class B-C, especially in combination with renal impairment, had a very low survival rate, and TAVR should be carefully considered to avoid a futile treatment. These results may contribute to improve the clinical decision-making process and management in patients with liver disease.
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.117.005727 | DOI Listing |
Inflammopharmacology
December 2024
Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, 5400, Pakistan.
Rheumatoid arthritis is an autoimmune disorder affecting multiple joints and requires lifelong treatment. Present study was designed to formulate Esculin-loaded chitosan nanoparticles (ENPs) and evaluation of its anti-inflammatory and anti-arthritic action. The acute toxicity study of ENPs was also performed.
View Article and Find Full Text PDFClin Exp Med
December 2024
Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Following a gluten-free diet (GFD) is known as the main effective therapy available for celiac disease (CD) patients, which in some cases is not enough to heal all patients presentations completely. Accordingly, emerging researchers have focused on finding novel therapeutic/preventive strategies for this disorder. Moreover, previous studies have shown that celiac patients, especially untreated subjects, are at increased risk of developing viral and bacterial infections, which can become a challenge for the clinician.
View Article and Find Full Text PDFTranspl Infect Dis
December 2024
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
This case involves a 52-year-old male, who underwent a deceased donor orthotopic liver transplant 7 months prior, presented with a 2-week history of persistent fever, anemia, thrombocytopenia, and mild elevation of liver enzymes. Upon hospital admission, the patient was febbrile, alert and oriented, hemodynamically stable. Laboratory exams revealed worsening leukopenia, anemia, thrombocytopenia, hyponatremia, and elevated ferritin.
View Article and Find Full Text PDFTranspl Infect Dis
December 2024
Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.
Introduction: The appropriate duration of therapy for uncomplicated gram-negative bloodstream infection (GN-BSI) in liver transplant (LTx) recipients remains unknown. This study aims to explore the effectiveness of a short-course antimicrobial therapy.
Methods: This retrospective study was performed in a single LTx center in Japan.
Clin Transplant
December 2024
Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Background: Postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) following pediatric liver transplantation (PLT) have not been comprehensively studied. This study aimed to evaluate the correlation between AKI and both 1-year CKD and mortality.
Methods: This retrospective study included 132 children aged between 3 months and 12 years who underwent PLT between 2017 and 2021.
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