Neurohormonal Inhibition and Outcomes in TAVR

Background:
Neurohormonal inhibition with beta-blockers (BB) and renin-angiotensin system inhibitor (RAS-i) has been postulated to decrease mortality, heart failure and hospital readmission in patients undergoing transcatheter aortic valve replacement (TAVR). Evidence to support this claim is inconclusive.

Methods
This is a retrospective cohort study of patients that underwent TAVR between April 2012 and March 2016 in a tertiary cardiovascular center. The presence of Neurohormonal inhibition with BB, RAS-i or both(BB +RAS-i) was assessed. Evaluated outcomes included 30-day and 1-year mortality, length of stay, acute kidney injury (AKI), and stroke.

Results
Out of 372 patients that underwent TAVR in our institution, 158 (42%) were female with a mean age of 84.9 ± 6.7 years and mean STS score of 6.93 ± 4.01. A total of 127 (34%) patients had heart failure with reduced ejection fraction, 291(78%) had hypertension, and 79(21%) had diabetes mellitus. Their mean creatinine was 1.13 ±0.58 mg/dl, mean AV-area was 0.65 ± 0.17 cm² and mean AV-gradient was 49.4 ± 13.2 mmhg. A transfemoral approach was performed in 261 (70%) of the patients. Neurohormonal inhibition was present in 324 (87%) patients, of these patients 284 (76.3%) were on BB, 151 (41%) were on RAS-i, and 111 (30%) were on BB + RAS-i. See Table 1 for clinically relevant outcomes.

Conclusions
This study suggests that neurohormonal inhibition with RAS-i is associated with lower hospital stay and 30-day mortality in patients undergoing TAVR. The rate of post TAVR AKI was not affected by the presence of RAS-i. Beta-blockers failed to demonstrate any significant outcome.