Key result
TAVR cuts in-hospital mortality ~49% vs. SAVR in patients with chronic liver disease.
Why the study?
Data comparing the outcomes of transcatheter and surgical aortic valve replacement in patients with chronic liver disease are limited.
Does TAVR reduce in-hospital mortality and improve secondary outcomes compared to SAVR in patients with chronic liver disease?
Meta-Analysis (n=2,231)
Does TAVR reduce in-hospital mortality and improve secondary outcomes compared to SAVR in patients with chronic liver disease?
Odds Ratio: 0.51 (95% CI 0.27–0.98)
Absolute Event Rate: 7.3% vs 13.2%
p-value: p=0.04
In patients with chronic liver disease, TAVR is associated with lower in-hospital mortality, fewer blood transfusions, and shorter hospital stays compared to SAVR.
May favor TAVR in chronic liver disease; leaves open need for randomized confirmation before practice change.
Background: Chronic liver disease increases cardiac surgical risk, with 30-day mortality ranging from 9% to 52% in patients with Child-Pugh class A and C, respectively. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. Methods: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant studies and assessed risk of bias using the Risk of Bias in Non-Randomized Studies – of Interventions (ROBINS-I) Cochrane Collaboration tool. Results: Five observational studies with 359 TAVR and 1,872 SAVR patients were included in the analysis. Overall, patients undergoing TAVR had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25, 1.82; I2=61%) than patients receiving SAVR. In propensity score–matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I2=13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I2=31%), and hospital length of stay (10.9 vs 15.7 days; mean difference –6.32; 95% CI –10.28, –2.36; I2=83%) than patients having SAVR. No significant differences between the 2 interventions were detected in the proportion of patients discharged home (65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I2=67%), acute kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I2= 0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized mean difference –0.07; 95% CI –0.29, 0.14; I2=0%). Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR.
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Ndunda et al. (2019) conducted a meta-analysis in Chronic liver disease and severe aortic stenosis (n=2,231). Transcatheter aortic valve replacement vs. Surgical aortic valve replacement was evaluated on In-hospital mortality (propensity score-matched cohort) (OR 0.51, 95% CI 0.27-0.98, p=0.04). In propensity score-matched patients with chronic liver disease, transcatheter aortic valve replacement significantly reduced in-hospital mortality compared to surgical replacement (OR 0.51).
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