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The prevalence and prognostic implications of pre-procedural hyperbilirubinemia in patients undergoing transcatheter aortic valve replacement

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Abstract

Preoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, this clinical significance is unclear with transcatheter aortic valve replacement (TAVR) procedures. The aims of this study were to determine the prevalence and prognostic implications of preoperative elevations of serum total bilirubin on TAVR outcomes. In 611 consecutive patients who underwent an elective TAVR procedure, 576 patients had recorded serum total bilirubin levels. Hyperbilirubinemia was defined as any value of serum total bilirubin ≥ 1.2 mg/dL obtained within 30-days prior to the TAVR procedure. The primary composite endpoint was post-TAVR all-cause in-hospital mortality or stroke. The overall prevalence of hyperbilirubinemia was 10% (n = 58). There were no patients with a prespecified diagnosis of liver cirrhosis. Pre-TAVR hyperbilirubinemia compared to normal bilirubin level was more common in younger (78 ± 10 vs. 82 ± 8 years old, p < 0.001) males (15 vs. 6%, p < 0.001), with history of pacemaker or ICD (33 vs. 18%, p = 0.005), congestive heart failure New York Heart Association class IV within 2 weeks from TAVR (35 vs. 14%, p < 0.001), severe tricuspid regurgitation (14 vs. 4%, p < 0.001), and atrial fibrillation or flutter (60 vs. 40%, p = 0.004, respectively). Pre-TAVR hyperbilirubinemia was independently associated with an increased post-TAVR in-hospital mortality (7 vs. 2% in normal bilirubin, p = 0.03), stroke (5 vs. 1%, p = 0.019, respectively), and a composite endpoint of death or stroke (12 vs. 3%, p < 0.001). Preoperative hyperbilirubinemia in patients undergoing TAVR is more prevalent than previously considered with multifactorial causes. Hyperbilirubinemia is independently associated with an increased post-TAVR in-hospital mortality and stroke.

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Authors and Affiliations

  1. Division of Cardiology, Albany Medical College/Albany Medical Center, Albany, NY, USA

    Stephanie Jou, Hiren Patel, Robert Zhang, Anthony Nappi, Mohammad El-Hajjar, Augustin DeLago & Mikhail Torosoff

  2. Department of Medicine, Columbia University Medical Center/NY Presbyterian Hospital, 622 West 168th Street, Floor 2, New York, NY, 10032, USA

    Stephanie Jou

  3. Department of Medicine, Albany Medical College/Albany Medical Center, Albany, NY, USA

    Hamza Oglat

  4. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Robert Zhang

  5. Division of Cardiothoracic Surgery, Albany Medical College/Albany Medical Center, Albany, NY, USA

    Li Zhang

  6. Division of Gastroenterology, Albany Medical College/Albany Medical Center, Albany, NY , USA

    Peter Ells

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  1. Stephanie Jou
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Jou, S., Patel, H., Oglat, H. et al. The prevalence and prognostic implications of pre-procedural hyperbilirubinemia in patients undergoing transcatheter aortic valve replacement. Heart Vessels 35, 1102–1108 (2020). https://doi.org/10.1007/s00380-020-01588-y

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