Clinical Outcomes of Transcatheter vs Surgical Aortic Valve Replacement in Patients With Chronic Liver Disease: A Systematic Review and Metaanalysis

Abstract

Background: Chronic liver disease increases cardiac surgical risk, with 30-day mortality ranging from 9% to 52% in patients with Child-Pugh class A and C, respectively. Data comparing the outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with liver disease are limited. Methods: We searched PubMed, Cochrane Library, Web of Science, and Google Scholar for relevant studies and assessed risk of bias using the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) Cochrane Collaboration tool. Results: Five observational studies with 359 TAVR and 1,872 SAVR patients were included in the analysis. Overall, patients undergoing TAVR had a statistically insignificant lower rate of in-hospital mortality (7.2% vs 18.1%; odds ratio [OR] 0.67; 95% confidence interval [CI] 0.25, 1.82; I 2 =61%) than patients receiving SAVR. In propensity score-matched cohorts, patients undergoing TAVR had lower rates of in-hospital mortality (7.3% vs 13.2%; OR 0.51; 95% CI 0.27, 0.98; I 2 =13%), blood transfusion (27.4% vs 51.1%; OR 0.36; 95% CI 0.21, 0.60; I 2 =31%), and hospital length of stay (10.9 vs 15.7 days; mean difference-6.32; 95% CI-10.28,-2.36; I 2 =83%) than patients having SAVR. No significant differences between the 2 interventions were detected in the proportion of patients discharged home (65.3% vs 53.9%; OR 1.3; 95% CI 0.56, 3.05; I 2 =67%), acute kidney injury (10.4% vs 17.1%; OR 0.55; 95% CI 0.29, 1.07; I 2 = 0%), or mean cost of hospitalization ($250,386 vs $257,464; standardized mean difference-0.07; 95% CI-0.29, 0.14; I 2 =0%). Conclusion: In patients with chronic liver disease, TAVR may be associated with lower rates of in-hospital mortality, blood transfusion, and hospital length of stay compared with SAVR.

TAVR versus SAVR in patients with severe aortic stenosis and concomitant end stage liver disease: When less is more

“…The latter finding might also be linked to the significantly lower rate of postprocedural atrial fibrillation observed in TAVR patients (31.5 vs. 48.2%, p < .01) and the consequent need for long-term anticoagulation, which poses ELSD patients at high risk for short and long-term bleeding events. The better prognosis of TAVR patients confirms the findings of a recent metaanalysis pooling data of patients with chronic liver disease, showing a significantly lower in-hospital mortality for subjects receiving TAVR as compared with SAVR (7.2 vs. 18.1%; OR 0.67; 95% CI 0.25, 1.82) 2.…”

Treatment of aortic stenosis in patients with chronic liver disease: Another win for transfemoral TAVR?

“…In fact, as compared to SAVR, patients undergoing TF‐TAVR were older (76.5 ± 9.5 vs. 71.6 ± 7.9 years, p = .020) and at higher baseline surgical risk (STS‐PROM 4.5 ± 6.6 vs. 2.0 ± 2.8%, p < .01). Moreover, while this report was not sufficiently powered to detect a statistically significant difference in perioperative mortality, in a recent meta‐analysis pooling data of patients with chronic liver disease, in‐hospital mortality was lower for those receiving TAVR as compared to SAVR (7.2% vs. 18.1%; OR = 0.67; 95% CI [0.25, 1.82]) …”

Contemporary trends and outcomes in aortic valve replacement in patients with end‐stage liver disease

“…[14][15][16][17][18] In comparison with TAVR, SAVR was associated with increased procedural related morbidities. A recent pooled analysis 19 including coagulopathy, increased risk of infection, fluid and electrolyte shifts, with limited respiratory and renal reserve, they are very likely to benefit from less invasive option provided by TAVR. [21][22][23] Therefore, in conclusion, our study supports TAVR is a safe option and a viable treatment options for aortic valve stenosis in patients with ESLD.…”

“…In comparison with TAVR, SAVR was associated with increased procedural related morbidities. A recent pooled analysis of clinical outcomes found significantly lower odds of in‐hospital, blood transfusion and periprocedural hospital length of stay, reduced cost of hospitalization, and reduced acute kidney injury in TAVR as compared to SAVR in patients with cirrhosis.…”