Key result
Peri-procedural glucocorticoid therapy did not reduce pacemaker implantation following TAVI (RR 0.91; 95% CI 0.73-1.14) but was associated with increased bleeding and vascular complications.
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Why the study?
Cardiac conduction disturbances after TAVI frequently require permanent pacemaker implantation and glucocorticoids have been proposed to reduce conduction injury by limiting inflammation and edema.
Does peri-procedural glucocorticoid therapy reduce conduction complications compared to standard care in adults undergoing TAVI?
Meta-Analysis (n=8,841)
Does peri-procedural glucocorticoid therapy reduce conduction complications compared to standard care in adults undergoing TAVI?
Relative Risk: 0.91 (95% CI 0.73–1.14)
Peri-procedural glucocorticoid therapy during TAVI does not reduce conduction-related complications and is associated with an increased risk of bleeding and vascular complications, suggesting caution against its routine use.
INTRODUCTION Cardiac conduction disturbances are common after transcatheter aortic valve implantation (TAVI) and frequently require permanent pacemaker implantation (PPI), associated with worse outcomes. Glucocorticoids have been proposed to reduce conduction injury by limiting inflammation and edema. AIMS To assess whether peri-procedural glucocorticoid therapy reduces conduction complications compared to standard care in TAVI patients. METHODS Systematic review and meta-analysis following Cochrane Handbook and PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library were searched through 2026. Randomized controlled trials and observational studies evaluating peri-procedural glucocorticoids in adults undergoing TAVI were included. Random-effects models estimated pooled risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS Nine studies (8841 patients) were analyzed. Glucocorticoid therapy did not reduce pacemaker implantation (RR 0.91, 95% CI 0.73-1.14), new-onset left bundle branch block (RR 0.94, 95% CI 0.71-1.24), or acute kidney injury (RR 1.10, 95% CI 0.69-1.74). Mortality did not differ between groups (RR 0.94, 95% CI 0.61-1.45). Conversely, glucocorticoids were associated with increased bleeding (RR 1.39, 95% CI 1.01-1.90) and vascular complications (RR 1.86, 95% CI 1.36-2.55). CONCLUSION Peri-procedural glucocorticoid therapy does not reduce conduction-related complications following TAVI and is associated with increased bleeding and vascular complications. These findings suggest caution regarding routine glucocorticoid use in contemporary TAVI practice.
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Suruagy-Motta et al. (2026) conducted a meta-analysis in Patients undergoing transcatheter aortic valve implantation (TAVI) (n=8,841). Peri-procedural glucocorticoid therapy vs. Standard care was evaluated on Pacemaker implantation (RR 0.91, 95% CI 0.73-1.14). Peri-procedural glucocorticoid therapy did not reduce pacemaker implantation following TAVI (RR 0.91; 95% CI 0.73-1.14) but was associated with increased bleeding and vascular complications.
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