Najla Y Beydoun1, Lyubov Tsytsikova1, Haesun Han1, Alberto Furzan1, Andrew Weintraub2, Fredrick Cobey3, Sadeq A Quraishi3
1 Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
2 Department of Medicine, Division of Cardiology, Tufts Medical Center; Tufts University School of Medicine, Boston, MA, USA
3 Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center; Tufts University School of Medicine, Boston, MA, USA
Background: As visceral protein expression may influence outcomes in patients with cardiovascular disease, we investigated whether pre-procedural albumin concentration is associated with length of stay (LOS) and 90-day mortality after transcatheter aortic valve repair (TAVR).
Methods: We retrospectively analyzed data from TAVR patients at our institution between January 2013 and December 2017. For all patients, baseline albumin concentration was assessed between one and four weeks before the procedure. To investigate the association between albumin concentration and outcomes, we performed regression analyses, controlling for Society of Thoracic Surgeons, New York Heart Association classification, and Kansas City Cardiomyopathy Questionnaire 12 scores.
Results: Three hundred eighty patients were included in the analyses. Cox-proportional hazards regression showed that patients with albumin concentrations <3.5 g/dL were 80% more likely to have prolonged ICU LOS (HR 1.79; 95%CI 1.04–2.57, P = 0.03) and 70% more likely to have prolonged hospital LOS (HR 1.68; 95%CI 1.01-2.46, P = 0.04) compared to patients with albumin concentrations >3.5 g/dL. Logistic regression showed that patients with albumin concentrations <3.5 g/dL were four times more likely to not survive to 90 days (OR 3.94; 1.13–12.63, P = 0.03) after their TAVR compared to patients with albumin concentrations >3.5 g/dL.
Conclusion: Our data suggest that patients with pre-procedural albumin concentrations <3.5 g/dL are at an increased risk of adverse outcomes after TAVR compared to patients with albumin concentrations ≥3.5 g/dL. Prospective studies are needed to determine whether risk stratification based on pre-procedural albumin can improve outcomes and whether targeted interventions can improve pre-procedural albumin concentrations in potential TAVR candidates.
Sadeq A Quraishi
Department of Anesthesiology and Perioperative Medicine; Tufts Medical Center; 800 Washington Street, Ziskind 6038; Boston, MA - 02118
Source of Support: None, Conflict of Interest: None
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