Meta-analysis of impact of liver disease on mortality after transcatheter aortic valve implantation.

Abstract

To evaluate whether liver disease is associated with increased mortality after transcatheter aortic valve implantation (TAVI) and whether TAVI is associated with decreased mortality compared to surgical aortic valve replacement (SAVR) in patients with liver disease, we performed meta-analyses of currently available studies. Studies reporting mortality in TAVI patients with liver disease versus those without liver disease and mortality after TAVI versus SAVR in patients with liver disease were eligible to be included. A relative risk (RR) or hazard ratio of mortality for TAVI patients with versus without liver disease and mortality for TAVI versus SAVR in patients with liver disease was extracted from each individual study. Study-specific estimates were combined in the random-effects model. We identified nine studies of TAVI patients with versus without liver disease and four studies of TAVI versus SAVR in patients with liver cirrhosis. Pooled analyses demonstrated no association of liver disease with early (in-hospital/30-day) mortality (P = 0.28), but a statistically significant association of liver disease with increases mid-term (1-2-year) mortality (hazard ratio 1.87, P < 0.00001) in TAVI patients, and no statistically significant difference in in-hospital mortality between TAVI and SAVR in patients with cirrhosis (RR 0.60, P = 0.12). There may be no impact of liver disease on early mortality in TAVI patients, negative impact of liver disease on mid-term mortality in TAVI patients, and no difference in in-hospital mortality between TAVI and SAVR in patients with liver cirrhosis.