Key result
TAVI cuts in-hospital mortality ~57% and lowers transfusion needs vs SAVR in chronic liver disease.
Why the study?
Chronic liver disease is a known risk factor for cardiovascular surgery, and evidence regarding TAVI in patients with chronic liver disease is scarce.
Does TAVI reduce in-hospital mortality compared to SAVR in patients with severe aortic stenosis and chronic liver disease?
Meta-Analysis (n=1,652)
Yes
Does TAVI reduce in-hospital mortality compared to SAVR in patients with severe aortic stenosis and chronic liver disease?
Effect estimate: OR 0.43 (95% CI 0.22-0.86)
Absolute Event Rate: 7.6% vs 16.5%
p-value: p=0.02
TAVI is associated with lower in-hospital mortality and reduced need for transfusion compared to SAVR in patients with severe aortic stenosis and chronic liver disease.
Supports TAVI over SAVR to reduce in-hospital mortality in chronic liver disease; extends meta-analytic evidence to this high-risk subgroup.
BACKGROUND: Chronic liver disease is traditionally conceived as a risk factor for cardiovascular surgery. Transcatheter aortic valve implantation (TAVI) has recently burgeoned to precede surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis at intermediate to high surgical risk. The evidence regarding TAVI in the patients with chronic liver disease is currently scarce. METHODS: This article aims to assess the application of TAVI technique in the patients with chronic liver disease. RESULTS: TAVI in the patients with chronic liver disease produced acceptable postoperative results. The post-TAVI outcomes were comparable between the patients with or without chronic liver disease, except for a lower rate of pacemaker implantation in the patients with chronic liver disease (OR, 0.49[0.27-0.87], P = .02). In the patients with chronic liver disease, compared to SAVR, TAVI led to a decrease in the in-hospital mortality (OR, 0.43[0.22-0.86], P = .02) and need for transfusion (OR, 0.39[0.25-0.62], P < .0001). The rest outcomes were similar between the 2 groups. CONCLUSIONS: This systematic review and meta-analysis supported that TAVI is a reliable therapeutic option for treating severe aortic stenosis in the patients with chronic liver disease. Future large-scale randomized controlled trials investigating the mid-term and long-term prognosis are needed to further verify these results.
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Ma et al. (2020) conducted a meta-analysis in Severe aortic stenosis and chronic liver disease (n=1,652). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital mortality (OR 0.43, 95% CI 0.22-0.86, p=0.02). Transcatheter aortic valve implantation significantly reduced in-hospital mortality (OR 0.43) and the need for transfusion compared to surgical aortic valve replacement in patients with chronic liver disease.
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