Urgent transcatheter aortic valve implantation significantly reduced in-hospital mortality compared to balloon aortic valvuloplasty (RR 0.53; 95% CI 0.39-0.71).
Meta-Analysis (n=21,020)
Does urgent TAVI reduce early post-interventional mortality compared to BAV in patients with aortic stenosis-related cardiogenic shock or acute decompensated heart failure?
In patients with aortic stenosis presenting with cardiogenic shock or acute decompensated heart failure, urgent TAVI is associated with significantly lower in-hospital mortality compared to BAV.
Effect estimate: RR 0.53 (95% CI 0.39-0.71)
Abstract Background Urgent transcatheter aortic valve implantation (TAVI) is increasingly performed in the urgent setting, in patients presenting with aortic stenosis (AS)-related cardiogenic shock or acute decompensated heart failure (HF), in order to timely improve patient outcomes, while limiting the risks associated with emergency aortic valve surgery. Despite TAVI is preferred over balloon aortic valvuloplasty (BAV), there are limited studies directly comparing the two interventions Purpose The aim of this systematic review and meta-analysis is to compare urgent TAVI and BAV in regards to early post-interventional mortality Methods We performed a systematic search in 3 different databases (MEDLINE/PubMed, Web of Science and Scopus). After selecting all appropriate studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a random effect meta-analysis was performed. Results A total of 6 studies and 21,020 individuals were included (TAVI: 10,597; BAV: 10,423) in the meta-analysis. The most common indication for urgent TAVI or BAV was cardiogenic shock, followed by acute decompensated HF. In regards to in-hospital mortality, TAVI was associated with significantly reduced mortality compared to BAV Risk Ratio(RR): 0.53; 95% Confidence Interval (95%CI): 0.39-0.71, while a trend towards reduced mortality with TAVI was also noted in 30 days, despite remaining borderline non-significant (RR: 0.53; 95%CI: 0.26-1.05). Conclusion This systematic review and meta-analysis shows that in the setting of urgent interventions for AS, TAVI is associated with improved survival, compared to BAV. Considering the limited number of studies, the observational nature of the included data and the absence of report of other adverse events, more research, directly comparing TAVI with BAV, is needed in order to investigate the benefit of urgent interventions in this setting.
Dimitriadis et al. (Sat,) conducted a meta-analysis in Aortic stenosis-related cardiogenic shock or acute decompensated heart failure (n=21,020). Urgent transcatheter aortic valve implantation (TAVI) vs. Balloon aortic valvuloplasty (BAV) was evaluated on In-hospital mortality (RR 0.53, 95% CI 0.39-0.71). Urgent transcatheter aortic valve implantation significantly reduced in-hospital mortality compared to balloon aortic valvuloplasty (RR 0.53; 95% CI 0.39-0.71).