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

Abstract

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 We performed a systematic review and meta-analysis of studies: 1) evaluating mortality with TAVR as compared to medical therapy in CA-AS patients, and 2) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared to patients with AS alone. Results A total of 8 observational studies were identified, 4 of which reporting mortality with TAVR and 4 reporting 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 as compared to medical therapy (OR 0.23, 95% CI 0.07–0.73, I²=0%, P=0.001, number needed to treat=3). The safety profile of TAVR seems to be similar in patients with CA-AS as compared to those with AS alone, 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 1.93, 95% CI 0.91–4.09, I2=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 to those with AS alone. Conclusions TAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared to medical therapy, and a safety profile comparable to patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.