title: Impact of pre-procedural serum albumin levels on outcome of patients undergoing transcatheter aortic valve replacement.
abstract: Risk assessment for transcatheter aortic valve replacement (TAVR) patients is challenging, and surgical scores do not optimally correlate with outcome. The aim of this study was to assess the correlation between serum albumin and survival of patients with symptomatic severe aortic stenosis undergoing TAVR. Patients with severe aortic stenosis who underwent TAVR were categorized into 2 groups according to low and normal preprocedural serum albumin (<3.5 and ≥3.5 g/dl, respectively). The all-cause mortality rates at hospital discharge, at 30-day and 1-year follow-up were compared across the groups. Additionally, a Cox proportional-hazards model was generated to assess the independent effect of serum albumin at 1-year follow-up. Among 567 consecutive patients who underwent TAVR, 476 (84%) had documented preprocedural serum albumin measurements. Of these, 50% had low serum albumin levels, and 50% had normal serum albumin levels. Baseline and procedural characteristics, including age, gender, and transapical access, were similar among the groups. Prevalence of left ventricular ejection fraction<40% was higher in patients with low albumin (29% vs 20%, p=0.02), and risk assessment according to Society of Thoracic Surgeons score tended to be higher in the low-albumin group (10±4.7 vs 9.4±4.4, p=0.09). Patients presenting with low albumin had higher in-hospital mortality (11% vs 5%), as well as at 30-day (12% vs 6%, p=0.01) and 1-year (29% vs 19%, p=0.02) follow-up. Serum albumin was independently associated with 1-year mortality (adjusted hazard ratio per 0.1 g/dl decrease 1.64, 95% confidence interval 2.50 to 1.75, p=0.02), along with body mass index<20 kg/m2 (hazard ratio 1.89, 95% confidence interval 3.33 to 1.75, p=0.03). In conclusion, preprocedural serum albumin level and low body mass index are independently associated with mortality in patients who undergo TAVR. Patients with severe aortic stenosis and low albumin levels should undergo careful evaluation before and after TAVR.
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Chen
authors.initials: C
authors.lastname: Fang
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Petros
authors.initials: P
authors.lastname: Okubagzi
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Sa'ar
authors.initials: S
authors.lastname: Minha
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Corso
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Christian
authors.initials: C
authors.lastname: Shults
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D013318:Stroke Volume; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014481:United States
chemical_list: D012709:Serum Albumin