What question did this study set out to answer?

The study aims to evaluate how advanced cardiac damage affects mortality and rehospitalisation following TAVI in patients with severe aortic stenosis.

March 8, 2026Open Access

Impact of advanced cardiac damage in severe aortic stenosis on short-term and mid-term mortality and rehospitalisation after transcatheter aortic valve implantation: a systematic review and meta-analysis

Key Result

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.

Key Points

The study aims to evaluate how advanced cardiac damage affects mortality and rehospitalisation following TAVI in patients with severe aortic stenosis.
Conducted a systematic review and meta-analysis of studies from PubMed, Scopus, and Web of Science
Included adults with severe aortic stenosis undergoing TAVI, reporting outcomes at 1, 6, or 12 months
Synthesised data using random-effects meta-analysis and performed subgroup analyses based on cardiac damage severity
Assessed risk of bias using Joanna Briggs Institute’s checklist for cohort studies
Included 34 studies with a total of 26,076 patients
Increased all-cause mortality correlated with advancing cardiac damage: HRs for stages 3 and 4 were 2.06 and 2.77 respectively
Cardiovascular mortality was highest in stage 4 with an HR of 3.13
Limited rehospitalisation data suggested an elevated risk in stage 3 (RR 1.33)

Structured PICO

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?

Population

34 studies including 26,076 adults with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)

Intervention

Presence of advanced extravalvular cardiac damage (right ventricular dysfunction, pulmonary hypertension, and tricuspid regurgitation, classified by Généreux staging)

Comparator

Absence of advanced cardiac damage or lower stages of cardiac damage

Outcome

All-cause mortality, cardiovascular mortality, and rehospitalisation at 1 month, 6 months, or 12 monthshard clinical

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.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

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.