What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Mixed aortic valve disease and aortic stenosis (n=9505). Intervention: Transcatheter aortic valve replacement (TAVR) for mixed aortic valve disease vs. Transcatheter aortic valve replacement (TAVR) for pure aortic stenosis. Primary outcome: 1-year all-cause mortality (HR 0.89, 95% CI 0.81-0.98).

December 25, 2022Open Access

Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis

JUJustin UgwuUniversity of Kansas Medical Center DKDaniel R. KandahMercy Medical Center JNJideofor K. NdulueUniversity of Nebraska at Omaha

Resultado clave

Transcatheter aortic valve replacement in patients with mixed aortic valve disease was associated with a lower risk of 1-year all-cause mortality compared to patients with pure aortic stenosis (HR 0.89).

Diseño del estudio

Tipo

Meta-Analysis (n=9,505)

PICO estructurado

Does TAVR improve 1-year all-cause mortality in patients with mixed aortic valve disease compared to those with pure aortic stenosis?

Población

9,505 patients undergoing transcatheter aortic valve replacement (TAVR) across 9 studies, mean age 81.6 years. The population compares patients with mixed aortic valve disease (MAVD; severe aortic stenosis with mild or more concurrent aortic regurgitation) versus pure aortic stenosis (AS).

Intervención

Transcatheter aortic valve replacement (TAVR) in patients with mixed aortic valve disease (MAVD)

Comparador

Transcatheter aortic valve replacement (TAVR) in patients with pure aortic stenosis (AS)

Resultado

1-year all-cause mortality following TAVRhard clinical

Patients with mixed aortic valve disease have similar or slightly improved 1-year survival after TAVR compared to those with pure aortic stenosis, despite a higher risk of post-TAVR aortic regurgitation.

Resultado numérico

Estimación del efecto: HR 0.89 (95% CI 0.81-0.98)

Limitaciones

Heterogeneity in the definition of MAVD
Details of the qualitative and quantitative parameters used to assess and grade the severity of pre-existing AR, MAVD and post TAVR AR are limited
Pathologic anatomy of aortic regurgitation was not accurately characterized
Did not have access to individual-level data
Significant publication bias was identified
Substantial between study heterogeneity

Resumen

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS. METHODS: We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR. RESULTS: Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81-0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72-0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20-1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89-3.14 vs. 0.93 95% CI 0.47-1.85. CONCLUSIONS: Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS.

Preguntar a la IA

Me gusta

Guardar

Ver artículo completo