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

S. Michel Pompeu, Xander Jacquemyn, Panagiotis T. Tasoudis, Jef Van den Eynde, Ozgun Erten, Aleksander Dokollari, Gianluca Torregrossa, Serge Sicouri, Alexander Weymann, Arjang Ruhparwar, Thanos Athanasiou, Basel Ramlawi

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

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.

Original languageEnglish
Pages (from-to)3300-3310
Number of pages11
JournalJournal of Cardiac Surgery
Volume37
Issue number10
DOIs
StatePublished - Oct 2022
Externally publishedYes

Keywords

  • bicuspid aortic valve disease
  • cardiac surgical procedures
  • cardiovascular surgical procedures
  • heart valve prosthesis implantation
  • heart valves
  • meta-analysis
  • transcatheter aortic valve replacement

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