Abstract
Introduction The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of emergent transcatheter aortic valve implantation (TAVI) in patients with decompensated aortic stenosis (AS) by comparing the clinical outcomes with the patients who had received the elective TAVI. Methods By searching PubMed, EMBASE, and Cochrane databases, we obtained the studies comparing the clinical outcomes of emergent TAVI and elective TAVI. Finally, 14 studies were included. Results A total of 14 eligible articles with 73,484 patients were included in this meta-analysis. Emergent TAVI was associated with a higher mortality during hospitalization (HR 2.09, 95% CI [1.39 to 3.14]), 30 days (HR 2.29, 95% CI [1.69 to 3.10]), and 1 year (HR 1.96, 95% CI [1.55 to 2.49]). Consistently, the incidence of acute kidney injury (AKI) (RR 2.48, 95% CI [1.85 to 3.32]), dialysis (RR 2.37, 95% CI [1.95 to 2.88]), bleeding (RR 1.62, 95% CI [1.27 to 2.08]), major bleeding (RR 1.05, 95% CI [1.00 to 1.10]), and 30-day rehospitalization (RR 1.30, 95% CI [1.07, 1.58]) were more common in patients receiving emergent TAVI. No statistical differences were found in the occurrence rate of vascular complications (RR 1.11, 95% CI [0.90, 1.36]), major vascular complications (RR 1.14, 95% CI [0.52, 2.52]), permanent pacemaker (PPM) placement (RR 1.05, 95% CI [0.99, 1.11]), cerebrovascular events (RR 1.11, 95% CI [0.98, 1.25]), moderate to severe paravalvular leakage (PVL) (RR 1.23, 95% [CI 0.94 to 1.61]), and device success (RR 0.99, 95% CI [0.97, 1.01]). Conclusion Emergent TAVI is associated with some postoperative complications and increased mortality compared with elective TAVI. Emergent TAVI should be implemented cautiously and individually.
Highlights
Aortic stenosis (AS) is one of the commonest valvular heart diseases, and its prevalence increased markedly with population aging [1, 2]
In the aspect of dialysis, through sensitivity analysis, we found that the study of Elbadawi et al [15] was a source of heterogeneity (Supplemental Figure S3(c)), so the observation was deleted. ere was no statistical heterogeneity in the remaining studies (I2 0%, P 0.530); meta-analysis showed that emergent transcatheter aortic valve implantation (TAVI) was inferior in the occurrence of dialysis (emergent vs selective, hazard ratio (HR) 2.37, 95% CI [1.95 to 2.88], Figure 5(b)). e prevalence
Main results of our systematic review and meta-analysis were as follows: (1) emergent TAVI was associated with higher incidence of 30-day, in-hospital, and 1-year mortality; and (2) in terms of postoperative adverse events, emergent TAVI had higher rates of acute kidney injury (AKI), dialysis, bleeding, and major bleeding
Summary
Aortic stenosis (AS) is one of the commonest valvular heart diseases, and its prevalence increased markedly with population aging [1, 2]. Several studies reported the application of emergent TAVI in acute decompensated AS. E inclusion criteria in this metaanalysis were 1 reporting outcome indicators for both emergent TAVI and elective TAVI; 2 randomized clinical trials and prospective/retrospective cohort studies; and 3 presenting the specific number or incidence of outcome indicators or displayed the survival curve. E exclusion criteria included 1 non-English literature; 2 repetitive published literature; 3 research that cannot extract or transform key data; and 4 certain publication type (e.g., case reports, reviews, meta-analysis, editorials, guidelines, and letters). Data extraction included but was not limited to 1 basic information of included studies: research topic, first author, published journal, etc.; 2 baseline characteristic and intervention measure of research objects; 3 key element of bias risk assessment; and 4 outcome indicators concerned. Begg’s rank correction test and Egger’s linear regression were performed, and P < 0.05 indicates that there might be publication bias
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