The association of prior carpal tunnel syndrome surgery with adverse cardiovascular outcomes and long-term mortality after aortic valve replacement

Abstract Aims Patients undergoing aortic valve replacement (AVR) for severe aortic stenosis have a 6–16% prevalence of occult cardiac amyloidosis. Carpal tunnel syndrome (CTS) is common in cardiac amyloidosis, but whether prior CTS surgery has a prognostic impact in patients undergoing AVR is unknown. This study examined the association between prior CTS surgery and adverse cardiovascular outcomes in patients treated with AVR. Methods and results Using Danish nationwide registries, we retrospectively identified patients undergoing first-time AVR from 2005 to 2018, examining the association between previous CTS and adverse cardiovascular outcomes the following 5 years after the AVR procedure. Cumulative incidence functions and adjusted Cox proportional hazard models were used to assess differences. Among 19,211 patients undergoing AVR, 2.5% (n = 472) had prior CTS surgery. Patients in the CTS-cohort were significantly older (median age 75.7 [IQR 68.1–82.3] vs 73.7 [IQR 66.0–79.6]), more often female and had more comorbidities. Prior CTS surgery was not associated with differences in hospitalization for heart failure (11.2% [95% CI 8.3–14.7] vs 9.4% [95% CI 9.0–9.9]), atrial fibrillation (11.1% [95% CI 8.2–14.5] vs 11.2% [95% CI 10.8–11.7]) or pacemaker implantation (6.2% [95% CI 4.0–9.0] vs 5.1% [95% CI 4.8–5.5]). The 5-year mortality (32.8% [27.6–38.0] vs 25.2% [24.5–25.9]) was higher in the CTS-cohort. CTS was significantly associated with increased 5-year mortality (HR 1.27 [1.05–1.53]) in crude models, however, after multivariable adjustment prior CTS surgery was not associated with adverse cardiovascular outcomes. Conclusion Previous CTS surgery was not associated with increased risk for adverse cardiovascular outcomes after AVR.