Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Acute Decompensated Aortic Stenosis: Systematic Review and Meta-Analysis

Ruochen Shao; Junli Li; Tianyi Qu; Xiaoying Fu; Yanbiao Liao; Mao Chen

doi:10.1155/2021/7230063

December 24, 2021Journal of Interventional CardiologyOpen Access

Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Acute Decompensated Aortic Stenosis: Systematic Review and Meta-Analysis

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Why the study?

The efficacy and safety of emergent TAVI in patients with decompensated aortic stenosis compared with elective TAVI required investigation.

Does emergent TAVI improve clinical outcomes compared to elective TAVI in patients with decompensated aortic stenosis?

Structured PICO

Does emergent TAVI improve clinical outcomes compared to elective TAVI in patients with decompensated aortic stenosis?

P

Population

73,484 patients with decompensated aortic stenosis (AS) from 14 studies

I

Intervention

Emergent transcatheter aortic valve implantation (TAVI)

C

Comparator

Elective TAVI

O

Outcome

Mortality during hospitalization, 30 days, and 1 yearhard clinical

Emergent TAVI in patients with decompensated aortic stenosis is associated with increased mortality and postoperative complications compared to elective TAVI, suggesting it should be implemented cautiously.

Implication

Emergent TAVI linked to higher mortality in decompensated AS; leaves open optimal timing and patient selection for prospective trials.

Abstract

INTRODUCTION: The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of emergent transcatheter aortic valve implantation (TAVI) in patients with decompensated aortic stenosis (AS) by comparing the clinical outcomes with the patients who had received the elective TAVI. METHODS: By searching PubMed, EMBASE, and Cochrane databases, we obtained the studies comparing the clinical outcomes of emergent TAVI and elective TAVI. Finally, 14 studies were included. RESULTS: A total of 14 eligible articles with 73,484 patients were included in this meta-analysis. Emergent TAVI was associated with a higher mortality during hospitalization (HR 2.09, 95% CI [1.39 to 3.14]), 30 days (HR 2.29, 95% CI [1.69 to 3.10]), and 1 year (HR 1.96, 95% CI [1.55 to 2.49]). Consistently, the incidence of acute kidney injury (AKI) (RR 2.48, 95% CI [1.85 to 3.32]), dialysis (RR 2.37, 95% CI [1.95 to 2.88]), bleeding (RR 1.62, 95% CI [1.27 to 2.08]), major bleeding (RR 1.05, 95% CI [1.00 to 1.10]), and 30-day rehospitalization (RR 1.30, 95% CI [1.07, 1.58]) were more common in patients receiving emergent TAVI. No statistical differences were found in the occurrence rate of vascular complications (RR 1.11, 95% CI [0.90, 1.36]), major vascular complications (RR 1.14, 95% CI [0.52, 2.52]), permanent pacemaker (PPM) placement (RR 1.05, 95% CI [0.99, 1.11]), cerebrovascular events (RR 1.11, 95% CI [0.98, 1.25]), moderate to severe paravalvular leakage (PVL) (RR 1.23, 95% [CI 0.94 to 1.61]), and device success (RR 0.99, 95% CI [0.97, 1.01]). CONCLUSION: Emergent TAVI is associated with some postoperative complications and increased mortality compared with elective TAVI. Emergent TAVI should be implemented cautiously and individually.