Advanced cardiac damage stages post-TAVI increase 12-month mortality: borderline HR 1.61, stage 3 HR 2.06, and stage 4 HR 2.77; stage 4 has highest CV mortality HR 3.13.
Does advanced cardiac damage (right ventricular dysfunction, pulmonary hypertension, tricuspid regurgitation) increase short-term and mid-term mortality and rehospitalisation in adults with severe aortic stenosis undergoing TAVI?
Advanced extravalvular cardiac damage, particularly right ventricular dysfunction (stage 4), is strongly associated with increased short-term and mid-term mortality and rehospitalisation after TAVI, highlighting the prognostic value of preprocedural cardiac damage staging.
Tasa de eventos absoluta: 0% vs 0%
Background Severe aortic stenosis (AS) is commonly associated with advanced cardiac damage, including right ventricular dysfunction (RVD), pulmonary hypertension (PH) and tricuspid regurgitation (TR), which may worsen prognosis after transcatheter aortic valve implantation (TAVI). This systematic review and meta-analysis aimed to assess the effect of these conditions on short-term and mid-term mortality and rehospitalisation following TAVI. Methods We conducted a systematic search of PubMed, Scopus and Web of Science for studies published up to June 2025. Eligible studies included adults with AS undergoing TAVI and reported outcomes at 1 month, 6 months or 12 months stratified by the presence of RVD, PH or TR. Studies had to report either HRs, risk ratios (RRs) or sufficient raw event data for mortality or rehospitalisation. Data were synthesised using a random-effects meta-analysis. Subgroup analyses were conducted by cardiac damage severity according to the Généreux staging system and stratified by valve type and diagnostic modality. Risk of bias in included studies was assessed using the Joanna Briggs Institute’s checklist for cohort studies. Meta-regression was performed to explore sources of between-study heterogeneity. Results A total of 34 studies including 26 076 patients met inclusion criteria. Twelve-month HRs for all-cause mortality increased with advancing cardiac damage: borderline stage HR 1.61 (1.22–2.12), stage 3 HR 2.06 (1.63–2.60) and stage 4 HR 2.77 (2.11–3.64). RRs followed a similar trend. Cardiovascular mortality was highest in stage 4 (HR 3.13 (1.20–8.17); RR 2.63 (1.54–4.47)). Rehospitalisation data were limited but suggested elevated risk in stage 3 (RR 1.33 (1.12–1.58)). Meta-regression indicated that age, sex and comorbidities contributed to between-study heterogeneity, particularly in stage 3 analyses. Conclusion Extravalvular cardiac damage, especially RVD (stage 4), is strongly associated with increased short-term and mid-term mortality and rehospitalisation after TAVI. Even borderline-stage patients face elevated risk, underscoring the continuous nature of AS-related cardiac injury. Incorporating cardiac damage staging into preprocedural assessment can enhance risk stratification and guide management to improve patient outcomes. PROSPERO registration number CRD420250638838.
Baay et al. (Fri,) reported a other. Advanced cardiac damage stages post-TAVI increase 12-month mortality: borderline HR 1.61, stage 3 HR 2.06, and stage 4 HR 2.77; stage 4 has highest CV mortality HR 3.13.