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Review
. 2024 Apr 15;14(2):54-69.
doi: 10.62347/PORE5631. eCollection 2024.

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis

Yasar Sattar  1 , Mohammad Hamza  2 , Farah Yasmin  3 , Sidra Jabeen  4 , Neel Patel  5 , Syed Ishaq  6 , Bandar Alyami  1 , Hassan Ul Hussain  7 , Syeda Tayyaba Rehan  7 , Syed Hasan Shuja  7 , Zayeema Khan  7 , Yasemin Bahar  8 , Islam Y Elgendy  9 , Karthik Gonuguntla  1 , Harshith Thyagaturu  1 , Akram Kawsara  1 , Kevin Felpel  1 , Ramesh Daggubati  1 , M Chadi Alraies  10
Affiliations
Review

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis

Yasar Sattar et al. Am J Cardiovasc Dis. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR.

Methods: We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software.

Results: A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group.

Conclusion: Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.

Keywords: Emergent TAVR; aortic stenosis; elective TAVR.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Flow of the search strategy for systematic review and meta-analysis.
Figure 2
Figure 2
Forest plot for Primary Outcome (30-day mortality and 30-day readmissions).
Figure 3
Figure 3
Graphical Abstract: Summarized primary and secondary outcomes of patients undergoing emergent TAVR or elective TAVR with or without BAV.
Figure 4
Figure 4
Peri-procedural outcomes of patients undergoing emergent TAVR or elective TAVR with or without BAV.
Figure 5
Figure 5
Vascular outcomes of patients undergoing emergent TAVR or elective TAVR with or without BAV.
Figure 6
Figure 6
Renal outcomes of patients undergoing emergent TAVR or elective TAVR with or without BAV.
See this image and copyright information in PMC

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