Immediate and late outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in bicuspid valves: Meta‐analysis of reconstructed time‐to‐event data

Abstract

Background Outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients with aortic stenosis and bicuspid aortic valve (BAV) must be better investigated. Methods A meta‐analysis including studies published by January 2022 reporting immediate outcomes (in‐hospital death, stroke, acute kidney injury [AKI], major bleeding, new permanent pacemaker implantation [PPI], paravalvular leakage [PVL]), mortality in the follow‐up (with Kaplan–Meier curves for reconstruction of individual patient data). Results Five studies met our eligibility criteria. No statistically significant difference was observed for in‐hospital death, stroke, AKI, and PVL. TAVI was associated with lower risk of major bleeding (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.12–0.69; p = .025), but higher risk of PPI (OR: 2.00; 95% CI: 1.05–3.77; p = .041). In the follow‐up, mortality after TAVI was significantly higher in the analysis with the largest samples (HR: 1.24, 95% CI: 1.01–1.53, p = .043), but no statistically significant difference was observed with risk‐adjusted populations (HR: 1.06, 95% CI: 0.86–1.32, p = .57). Landmark analyses suggested a time‐varying risk with TAVI after 10 and 13 months in both largest and risk‐adjusted populations (HR: 2.13, 95% CI: 1.45–3.12, p < .001; HR: 1.7, 95% CI: 1.11–2.61, p = .015, respectively). Conclusion Considering the immediate outcomes and comparable overall survival observed in risk‐adjusted populations, TAVI can be used safely in selected BAV patients. However, a time‐varying risk is present (favoring SAVR over TAVI at a later timepoint). This finding was likely driven by higher rates of PPI with TAVI.

TAVISCORE: a computer program for risk stratification of complications after aortic valve interventions in patients with reduced ejection fraction

“…4. PHLEBOSCORE -программа для определения риска развития рецидива варикозной болезни вен нижних конечностей после различных вариантов лечения, среди которых комбинированная флеб эктомия, эндовазальная лазерная облитерация, радиочас тотная аблация 1 .…”

“…1 , Ленинг К. С. 1 Цель. Демонстрация компьютерной программы TAVISCORE, которая предназначена для стратификации риска осложнений после вмешательств на аортальном клапане (АК) у пациентов со сниженной фракцией выброса.…”

“…Реконструктивные вмешательства на аортальном клапане (АК) всегда находились в центре внимания кардиохирургов [1,2]. В настоящее время существует два наиболее популярных варианта коррекции стеноза АК: открытое протезирование (ОПАК) и транскатетерная имплантация АК (ТИАК) [3].…”

Cusp‐overlap versus coplanar view in transcatheter aortic valve implantation with self‐expandable valves: A meta‐analysis of comparative studies

“…2,3 Among several post-TAVI complications, conduction abnormalities requiring permanent pacemaker implantation (PPI) are considered relatively common and are associated with clinical/ technical factors 4 and higher rates of death and rehospitalization for heart failure over time. 5,6 As a means to improve outcomes, the cusp-overlap (COV) technique 7 arose as a viable solution to reduce the rates of PPI after TAVI in comparison with the coplanar view (CPV), however, the evidence available remains scarce despite the popularity of the technique in the context of TAVI with self-expandable valves (SEVs).…”

Does valve morphological type impact TAVR outcomes?

“…BAV occurs in 1%-2% of the total population and represents about a third of the patients 80 years of age. 3 A recent meta-analysis by Sá et al 4 of this issue of the Journal of Cardiac Surgery provided an insight into the short-and midterm outcomes of early adoption of TAVR in BAV4. They pooled the results from five observational studies and reconstructed time-toevent data based on the published Kaplan-Meier graphs from the included studies.…”