Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Sep 21;4(9):e002096.
doi: 10.1161/JAHA.115.002096.

Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Tian-Yuan Xiong  1 , Yan-Biao Liao  1 , Zhen-Gang Zhao  1 , Yuan-Ning Xu  1 , Xin Wei  1 , Zhi-Liang Zuo  1 , Yi-Jian Li  1 , Jia-Yu Cao  1 , Hong Tang  1 , Hasan Jilaihawi  2 , Yuan Feng  1 , Mao Chen  1
Affiliations
Meta-Analysis

Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Tian-Yuan Xiong et al. J Am Heart Assoc. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death.

Methods and results: The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005).

Conclusions: Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.

Keywords: aortic stenosis; death; transcatheter valve replacement.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Summary of evidence search and selection. TAVR indicate Transcatheter aortic valve replacement.
Figure 2
Figure 2
Overall analysis of causes of death within the first 30 days following transcatheter aortic valve replacement.
Figure 3
Figure 3
Overall analysis of causes of death after the first 30 days following transcatheter aortic valve replacement (TAVR). Figure 2 and 3 show causes of death post-TAVR per time interval, with total patients included (N), deaths (n), and the blue parts standing for noncardiovascular causes and the green parts for cardiac/procedure-related causes.
Figure 4
Figure 4
Overall analysis in both durations, within 30 days and after 30 days of the valve procedure.
Figure 5
Figure 5
Subgroup analysis by access. TA indicates transapical; TF, transfemoral.
Figure 6
Figure 6
Subgroup analysis by types of prosthesis. ESV indicates Edwards SAPIEN valve; MCV, Medtronic CoreValve.
Figure 7
Figure 7
Subgroup analysis by mean Society of Thoracic Surgeons (STS) score.
See this image and copyright information in PMC

References

    1. Webb JG, Wood DA. Current status of transcatheter aortic valve replacement. J Am Coll Cardiol. 2012;60:483–492. - PubMed
    1. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, Thourani VH, Babaliaros VC, Webb JG, Herrmann HC. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012;366:1696–1704. - PubMed
    1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–2198. - PubMed
    1. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Jr, Kleiman NS. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–1798. - PubMed
    1. Zhang L, Chen LM, Wang MN, Chen XJ, Li N, De Huang Y, Chen M. The G894t, T-786c and 4b/a polymorphisms in Enos gene and cancer risk: a meta-analysis. J Evid Based Med. 2014;7:263–269. - PubMed

Publication types

MeSH terms