Short- and long-term outcomes in dialysis patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
Publication date: Available online 24 January 2020Source: Canadian Journal of CardiologyAuthor(s): Toshiki Kuno, Hisato Takagi, Tomo Ando, Hiroki Ueyama, Fujisaki Tomohiro, Masaki Kodaira, Yohei Numasawa, Alexandros Briasoulis, Kentaro HayashidaAbstractBackgroundTranscatheter aortic valve implantation (TAVI) has become the main treatment for symptomatic severe aortic stenosis but patients on dialysis have been excluded from major randomized controlled trials. Our aim was to compare mortality and procedure-related complications after TAVI in patients with end-stage renal disease (ESRD) on dialysis versus those without.MethodsEMBASE and MEDLINE were searched through November 2019 to investigate the comparative outcomes between ESRD patients on dialysis and those without who underwent TAVI. The main outcomes were short-term (30-day/in-hospital) mortality and procedural complications, and long-term (> 6 months) all-cause mortality.ResultsOur search identified 10 observational studies enrolling 128,094 (5,399 on dialysis) patients who underwent TAVI. Dialysis patients had a significantly higher rate of short-term and long-term mortality than non-dialysis patients (odds ratio [95% confidential interval]: 2.18 [1.64-2.89], P
New-generation devices such as Evolut and Portico have provided favorable results in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis, but their comparative effectiveness remains debated, despite its relevance when envisioning TAVI in low-risk patients. We evaluated the safety and efficacy of 2 leading TAVI devices (Evolut and Portico) used by the same team of experienced TAVI operators, focusing long-term outcomes, including the major adverse events (i.e. the composite of death, stroke, myocardial infarction, major vascular complication or major bleeding).
CONCLUSIONS: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, esp...
CONCLUSION: Mortality in CS patients due to decompensated severe AS is high, regardless of interventional treatment strategy. Both eBAV and eTAVR seem feasible. As eTAVR is associated with better initial improvements in hemodynamics and simultaneously avoids sequential interventions, it might be favorable to eBAV in select patients. If eTAVR is not available, eBAV might serve as a "bridge" to elective TAVR. PMID: 31611428 [PubMed - as supplied by publisher]
CONCLUSIONS: in patients who are at low surgical risk, TAVI seems to be associated with equivalent mortality up to a median follow up of 2 years compared to SAVR. More data is required before TAVI can be routinely considered as an alternative for SAVR in low risk patients. PMID: 31566571 [PubMed - as supplied by publisher]
Publication date: Available online 27 September 2019Source: The LancetAuthor(s): Jonas Lanz, Won-Keun Kim, Thomas Walther, Christof Burgdorf, Helge Möllmann, Axel Linke, Simon Redwood, Christian Thilo, Michael Hilker, Michael Joner, Holger Thiele, Lars Conzelmann, Lenard Conradi, Sebastian Kerber, Gerhard Schymik, Bernard Prendergast, Oliver Husser, Stefan Stortecky, Dik Heg, Peter JüniSummaryBackgroundTranscatheter aortic valve replacement (TAVR) is the preferred treatment option for older patients with symptomatic severe aortic stenosis. Differences in the properties of available TAVR systems can affect clinica...
AbstractPurpose of ReviewWe conducted a comprehensive and updated overview on complications occurring after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.Recent FindingsDespite remarkable improvements in patient selection, devices, procedures, and ancillary management, complications may still occur in patients undergoing TAVI. On top of most commonly described adverse events such as death, myocardial infarction, stroke, bleeding, vascular complication, renal failure, pacemaker implantation and residual valve regurgitation, other less common but similarly severe complications may still occur. The...
ConclusionPostprocedural incidence of ≥ moderate PAR, early all‐cause mortality, early incidence of MI, and midterm all‐cause mortality after TAVI are higher in patients with MS than in patients with no‐MS.
CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis. PMID: 31596707 [PubMed - in process]
Conclusions: TAVR is comparable to SAVR in terms of mortality and disabling stroke in severe AS patients at low and intermediate risk, but higher proportion of AV re-intervention observed in TAVR. Those results should encourage caution when extending the indications of TAVR into low risk patients, especially for young low risk patients. Systematic review registration: PROSPERO CRD 42018112626. PMID: 31285888 [PubMed]
ConclusionsRecent AHF is associated with increased risk of mortality and morbidity after SAVR and TAVR. These findings suggest that AS patients should be referred for invasive treatment before the development of clinically evident heart failure.