Aortic valve surgery in patients with Takayasu's arteritis: a nationwide analysis of 1,197 patients during a 9-year period

Abstract

Objectives: Takayasu's arteritis (TAK) is associated with an elevated risk of valvular heart disease, especially in the aortic valve. This study aimed to evaluate the rate and risk factors of aortic valve surgery (AVS) in patients with TAK.

Methods: The clinical data of 1,197 patients were identified in the Korean National Health Insurance Claims database between 2010 and 2018. Case ascertainment was done by using the ICD-10 code of TAK and inclusion in the Rare Intractable Diseases registry. The incidence rate/1,000 person-years was calculated to compare the age- and sex- adjusted incidence rate ratio (IRR) of AVS according to the time period between TAK diagnosis and AVS: <1 year, 1-2 years, 2-3 years, and 3 years. Evaluation of factors associated with AVS was performed using a time-dependent Cox regression analysis.

Results: Forty-five patients (3.8%) underwent AVS during the follow-up. The mean follow-up duration of patients with AVS was 1.2 years, and two-thirds of the patients (66.7%) underwent AVS within 1 year. The adjusted IRR was significantly higher among patients who underwent AVS <1 year after the diagnosis of TA than among those who underwent AVS ≥3 years after diagnosis (adjusted IRR: 10.31; 95% confidence interval [CI]: 4.29-24.81). A history of hypertension before the diagnosis of TAK was an independent risk factor for AVS (adjusted hazard ratio: 2.18; 95% CI: 1.12-4.24).

Conclusions: Approximately 4% of patients with TAK undergo AVS, usually within the first year of TAK diagnosis. Previous history of hypertension is a risk factor for AVS.