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A meta-analysis of impact of low-flow/low-gradient aortic stenosis on survival after transcatheter aortic valve implantation

Takagi, Hisatoa,b; Hari, Yosukea,b; Kawai, Norikazua; Kuno, Toshikic; Ando, Tomod for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group

Journal of Cardiovascular Medicine: October 2019 - Volume 20 - Issue 10 - p 691–698
doi: 10.2459/JCM.0000000000000836
Research articles: Valve disease
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Aims To determine whether low-flow/low-gradient (LF/LG) aortic stenosis affects survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies.

Methods MEDLINE and EMBASE were searched through January 2019 using PubMed and OVID. Observational studies comparing all-cause mortality after TAVI for patients with classical LF/LG (C/LF/LG) aortic stenosis versus normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG (P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG aortic stenosis versus P/LF/LG aortic stenosis were included. Study-specific estimates, risk and hazard ratios of mortality, were combined in the random-effects model.

Results Our search identified nine eligible studies including a total of 5512 TAVI patients. Pooled analysis demonstrated significantly higher early mortality in C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P = 0.02) and no statistically significant difference in early mortality between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51). Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003) and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P < 0.0001) was significantly higher than that in NF/HG aortic stenosis. There was no statistically significant difference in midterm mortality between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.63).

Conclusion After TAVI, C/LF/LG aortic stenosis is associated with increased early mortality compared with NF/HG, and C/LF/LG and P/LF/LG aortic stenosis is associated with increased midterm mortality compared with NF/HG aortic stenosis despite no difference in early mortality between P/LF/LG aortic stenosis and NF/HG aortic stenosis. There is no difference in early and midterm mortality between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis.

aDepartment of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka

bDepartment of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan

cDepartment of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York

dDepartment of Cardiology, Detroit Medical Center, Detroit, Michigan, USA

Correspondence to Hisato Takagi, MD, PhD, Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan E-mail: kfgth973@ybb.ne.jp

Received 13 November, 2018

Revised 26 February, 2019

Accepted 2 April, 2019

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© 2019 Italian Federation of Cardiology. All rights reserved.