“Diabetes has been implicated as a poor prognostic factor in several procedures, including percutaneous coronary intervention (PCI), coronary artery bypass graft surgery (CABG), and surgical aortic valve replacement (SAVR),” the authors wrote. authors. “Plausible explanations for the adverse outcomes of cardiac surgery in patients with diabetes compared to non-diabetics include increased inflammation and oxidative stress and impaired regression of left ventricular mass. In the case of stenosis aortic valve, diabetes is associated with rapid progression of valvular disease, increased hypertrophic remodeling, and decreased systolic and diastolic function of the left ventricle.
Atrial fibrillation and chronic kidney disease, they added, have both been linked to a higher risk of heart failure in other patient populations.
“Chronic kidney disease alters the natural history of aortic stenosis, most likely by promoting calcium deposition on the aortic valve leaflets, thereby worsening aortic stenosis and decreasing cardiac output,” the authors wrote. “Reduced flow to vital organs precipitates complications after TAVR.”
Some factors studied by the team were not associated with an increased risk of HF hospitalizations post-TAVR. These included age, low left ventricular ejection fraction, and New York Heart Association Class 3 symptoms.
To help improve TAVI outcomes and help this procedure have an even greater impact on patient care in years to come, Yasmin and her colleagues emphasized the importance of identifying risk factors early on, manage these conditions as well as possible before the procedure is scheduled. place and monitor the patient even after the most successful TAVR procedure.
“Bearing in mind the cost and expertise invested in pre- and peri-procedural care for TAVI, equal attention should be paid to post-procedural outcomes,” the authors concluded. “Careful follow-up after TAVI, with closer monitoring of HF in particular, is essential to prevent HF-related hospitalizations and deaths. Future research should focus on finding new predictors of HF. CI and assess whether a follow-up intervention, such as improved medical care, has an effect on the prognosis of this subset of patients.