Urgent TAVI not associated with higher rates of conversion to urgent cardiac surgery: a systematic review and meta-analysis

Abstract

Abstract Funding Acknowledgements None. Introduction Transcatheter Aortic Valve Implantation (TAVI) has been established as a therapeutic option in patients with severe Aortic valve Stenosis (AoS). Although TAVI has been associated with high procedural success, it is rarely required conversion to cardiac surgery, for the management of complications. It remains unknown whether the rate of conversion to urgent cardiac surgery is higher in patients undergoing urgent TAVI compared to elective TAVI. Purpose The aim of our systematic review and meta-analysis is to investigate whether patients treated with urgent TAVI are under higher risk for urgent conversion to cardiac surgery. Methods We systematically conducted a thorough search of three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) to identify studies comparing urgent and elective TAVI. Our primary endpoint in this systematic review and meta-analysis was the incidence of unanticipated, emergent conversions to open cardiac surgery during the TAVI procedure. Only studies that provided data on this endpoint were considered for inclusion in our analysis. Secondary endpoints included vascular complications, the presence of post-procedural moderate or severe aortic regurgitation, in-hospital mortality, and the device success. These secondary endpoints were evaluated during the inpatient stay of the patients. For the statistical analysis, we computed risk ratios (RR) with corresponding 95% confidence intervals (CIs). We employed a random-effects model (Mantel-Haenszel), to estimate the pooled RR. Results A total of six studies, encompassing 70,296 patients, were included in our analysis. Among them, 5,021 patients underwent an urgent TAVI procedure, while the remaining 65,275 underwent elective TAVI. During TAVI, conversion to urgent cardiac surgery did not vary significantly between the two groups (RR: 0.90, 95% CI:0.66-1.24]. Moreover, no significant differences were observed in vascular complications (RR:1.55, 95% CI: 0.92-2.61), post-procedural moderate or severe aortic regurgitation (RR:1.20, 95% CI: 0.85-1.69) and device success (RR:0.99, 95% CI: 0.98-1.00). Notably, in-hospital mortality was higher in urgent TAVR group (RR: 2.08, 95% CI: 1.69-2.56). Conclusion Our systematic review and meta-analysis have demonstrated that patients undergoing urgent TAVI are not at a higher risk for urgent cardiac surgery, device failure, vascular complications, or post-procedural moderate or severe aortic regurgitation. Notably, despite these findings, the higher in-hospital mortality observed in patients undergoing urgent TAVI suggests the presence of other factors that should be explored to account for this increased mortality.Urgent conversion to surgery