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.

背景：经导管主动脉瓣植入术 （TAVI） 是一种针对有症状的严重主动脉瓣狭窄 （AS） 患者的成熟治疗方法。有时会遇到服用免疫抑制剂的重度 AS 患者。调查免疫抑制治疗对 TAVI 后 AS 患者临床结局的影响。

方法和结果：总共回顾了 2016 年 1 月至 2018年12月在圣玛丽安娜大学医学院接受经股动脉 TAVI 的连续 282 例重度 AS 患者。他们分为 2 组：免疫抑制剂组 （IM 组） 患者持续使用免疫抑制药物 （n=22） 和非免疫抑制剂组 （non-IM 组） （n=260）。评估了定义为非致命性心肌梗死、不稳定型心绞痛、需要住院治疗的心力衰竭、中风和心血管死亡的主要不良心脑血管事件 （MACCE） 的复合终点。IM 组和非 IM 组血管通路并发症的发生率 （32% vs. 20%，P=0.143） 和手术成功率 （100% vs. 93%，P=0.377） 差异无统计学意义。在 TAVI 手术后 567 （16-1,312） 天的中位随访期内，IM 组和非 IM 组在感染并发症发生率 （14% vs. 9%，P=0.442） 或 MACCE （分别为 18% vs. 20% ;P=0.845）。

结论：对于接受 TAVI 治疗的重度 AS 患者，TAVI 后使用 IM 与血管通路并发症或中期 MACCE 增加无关。