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Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis

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Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Cannata, Francesco
  • Chiarito, Mauro
  • Pinto, Giuseppe
  • Villaschi, Alessandro
  • Fazzari, Fabio
  • Regazzoli, Damiano
  • Mangieri, Antonio
  • Bragato, Renato M.
  • Colombo, Antonio
  • Reimers, Bernhard
  • Condorelli, Gianluigi
  • Stefanini, Giulio G.

Grupos

Abstract

Aims Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA-AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA-AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA-AS patients. Methods and results We performed a systematic review and meta-analysis of studies: (i) evaluating mortality with TAVR as compared with medical therapy in CA-AS patients and (ii) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared with patients with AS alone. A total of seven observational studies were identified: four reported mortality with TAVR, and four reported complications and clinical outcomes after TAVR of patients with CA-AS compared with AS alone patients. In patients with CA-AS, the risk of mortality was lower with TAVR (n = 44) as compared with medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval (CI) 0.07-0.73, I-2 = 0%, P = 0.001, number needed to treat = 3]. The safety profile of TAVR seems to be similar in patients with CA-AS (n = 75) as compared with those with AS alone (n = 536), with comparable risks of stroke, vascular complications, life-threatening bleeding, acute kidney injury, and 30 day mortality, although CA-AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.76, 95% CI 0.91-4.09, I-2 = 0%, P = 0.085). CA is associated with a numerically higher rate of long-term mortality and rehospitalizations following TAVR in patients with CA-AS as compared with those with AS alone. Conclusions TAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared with medical therapy, and a safety profile comparable with patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.

© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

Datos de la publicación

ISSN/ISSNe:
2055-5822, 2055-5822

ESC Heart Failure  WILEY PERIODICALS, INC

Tipo:
Article
Páginas:
3188-3197
PubMed:
35770333
Factor de Impacto:
0,797 SCImago ℠
Cuartil:
Q2 SCImago ℠

Citas Recibidas en Web of Science: 38

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Keywords

  • Cardiac amyloidosis; Aortic stenosis; Transcatheter aortic valve replacement; Transthyretin amyloidosis; Light-chain amyloidosis

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