Effect of Immunosuppressive Therapy on Clinical Outcomes for Patients With Aortic Stenosis Following Transcatheter Aortic Valve Implantation

Toshiki Kaihara; Masaki Izumo; Haruka Kameshima; Yukio Sato; Shingo Kuwata; Masashi Koga; Mika Watanabe; Kazuaki Okuyama; Ryo Kamijima; Yuki Ishibashi; Yasuhiro Tanabe; Takumi Higuma; Tomoo Harada; Yoshihiro J. Akashi

doi:10.1253/circj.CJ-20-0600

This article has now been updated. Please use the final version.

Effect of Immunosuppressive Therapy on Clinical Outcomes for Patients With Aortic Stenosis Following Transcatheter Aortic Valve Implantation

Toshiki Kaihara, Masaki Izumo, Haruka Kameshima, Yukio Sato, Shingo Kuwata, Masashi Koga, Mika Watanabe, Kazuaki Okuyama, Ryo Kamijima, Yuki Ishibashi, Yasuhiro Tanabe, Takumi Higuma, Tomoo Harada, Yoshihiro J. Akashi

Author information

Toshiki Kaihara
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Masaki Izumo
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Haruka Kameshima
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Yukio Sato
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Shingo Kuwata
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Masashi Koga
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Mika Watanabe
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Kazuaki Okuyama
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Ryo Kamijima
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Yuki Ishibashi
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Yasuhiro Tanabe
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Takumi Higuma
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Tomoo Harada
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]
Yoshihiro J. Akashi
Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine [Japan]

Keywords: Immunosuppressants, Transcatheter aortic valve implantation, Vascular access complications

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Supplementary material

Article ID: CJ-20-0600

DOI https://doi.org/10.1253/circj.CJ-20-0600

The final version of this article is now available: Vol. 84 (2020), No. 12 pp. 2296-2301

Details

Abstract

Background:Transcatheter aortic valve implantation (TAVI) is an established treatment for symptomatic patients with severe aortic stenosis (AS). Sometimes patients with severe AS taking immunosuppressants are encountered. The effect of immunosuppressive therapy on clinical outcomes in patients with AS following TAVI were investigated.

Methods and Results:In total, 282 consecutive patients with severe AS who underwent transfemoral TAVI from January 2016 to December 2018 at St. Marianna University School of Medicine were reviewed. They were divided into 2 groups: the immunosuppressants group (IM group) in which patients continually used immunosuppressive drugs (n=22) and the non-immunosuppressants group (non-IM group) (n=260). The composite endpoints of a major adverse cardiovascular and cerebrovascular event (MACCE) defined as non-lethal myocardial infarction, unstable angina pectoris, heart failure requiring hospitalization, stroke, and cardiovascular death were evaluated. There were no differences in the incidence of vascular access complications (32% vs. 20%, P=0.143) and the rate of procedure success (100% vs. 93%, P=0.377) between the IM and non-IM groups. During the median follow-up period of 567 (16–1,312) days after the TAVI procedure, there were no significant differences between the IM and non-IM groups in the incidence of infectious complications (14% vs. 9%, P=0.442) or MACCE (18% vs. 20%, respectively; P=0.845).

Conclusions:The use of IM after TAVI is not associated with increased vascular access complications or mid-term MACCE in patients with severe AS treated with TAVI.

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