Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis

Yasar Sattar; Mohammad Hamza; Farah Yasmin; Sidra Jabeen; Neel Patel; Syed Ishaq; Bandar Alyami; Hassan Ul Hussain; Syeda Tayyaba Rehan; Syed Hasan Shuja; Zayeema Khan; Yasemin Bahar; Islam Y Elgendy; Karthik Gonuguntla; Harshith Thyagaturu; Akram Kawsara; Kevin Felpel; Ramesh Daggubati; M Chadi Alraies

doi:10.62347/PORE5631

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis

Am J Cardiovasc Dis. 2024 Apr 15;14(2):54-69. doi: 10.62347/PORE5631. eCollection 2024.

Authors

Yasar Sattar¹, Mohammad Hamza², Farah Yasmin³, Sidra Jabeen⁴, Neel Patel⁵, Syed Ishaq⁶, Bandar Alyami¹, Hassan Ul Hussain⁷, Syeda Tayyaba Rehan⁷, Syed Hasan Shuja⁷, Zayeema Khan⁷, Yasemin Bahar⁸, Islam Y Elgendy⁹, Karthik Gonuguntla¹, Harshith Thyagaturu¹, Akram Kawsara¹, Kevin Felpel¹, Ramesh Daggubati¹, M Chadi Alraies¹⁰

Affiliations

¹ Department of Cardiology, West Virginia University Morgantown, WV 26506, USA.
² Department of Internal Medicine, Albany Medical Center Albany, NY 12208, USA.
³ Yale School of Medicine New Haven, CT 06519, USA.
⁴ Liaquat National Hospital and Medical College Karachi 74800, Pakistan.
⁵ Department of Internal Medicine, New York Medical College/Landmark Medical Center Woonsocket, RI 02895, USA.
⁶ Sinai Hospital of Baltimore, Life Bridge Health Baltimore, MD 21215, USA.
⁷ Department of Internal Medicine, Dow University of Health Sciences Karachi 74200, Pakistan.
⁸ Wayne State University Detroit, MI 48201, USA.
⁹ University of Kentucky Lexington, KY 40506, USA.
¹⁰ Detroit Medical Center/Wayne State University Detroit, MI 48201, USA.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR.

Methods: We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software.

Results: A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group.

Conclusion: Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.

Keywords: Emergent TAVR; aortic stenosis; elective TAVR.

Publication types

Review