BACKGROUND: The so-called cardiohepatic syndrome (CHS) has recently been identified as an important prognostic parameter predicting survival after transcatheter tricuspid valve edge-to-edge repair. Until today, prevalence and prognostic significance of CHS have not been studied in the setting of transcatheter aortic valve replacement (TAVR).

OBJECTIVES: The aim of this study was to evaluate the prevalence and prognostic value of CHS in patients undergoing TAVR for severe aortic stenosis (AS).

METHODS: The study included patients who underwent TAVR at our institution from July 2013 until December 2019. In line with preexisting literature, CHS was defined as elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal (bilirubin, alkaline phosphatase [AP], and gamma glutamyl transferase [GGT]). Patients with missing information on bilirubin, AP and GGT were excluded. Primary endpoint of the study was three-year all-cause mortality. Secondary endpoints included technical and device failure, as well as heart failure symptoms which were assessed by New York Heart Association (NYHA) functional class over the course of follow-up.

RESULTS: Among a total of 2038 included patients (49.6% females, median age 81.0 [77.0-85.0] years) CHS was present in 212 patients (10.4%). CHS was associated with impaired left ventricular systolic function (LVEF), left and right ventricular and atrial dilation and a higher percentage of moderate-to-severe or severe concomitant mitral- and tricuspid regurgitation. In patients with vs. without CHS, rates of technical (4.7% vs. 5.6%, p=0.58) and device failure (17.5% vs. 13.9%, p=0.16) were comparable. NYHA functional class improved from baseline to follow-up irrespective of hepatic function. One- two- and three-year survival rates were significantly lower in patients with CHS (1y: 71.2% vs. 84.7%; 2y: 59.7% vs. 75.3%; 3y: 48.9% vs. 66.7% all p<0.001, Figure 1). The predictive value of CHS persisted after adjusting for the Society of Thoracic Surgeons (STS) score (hazard ratio 1.50, 95% confidence interval 1.24-1.82, p<0.01).