Mortality risk after TAVI comparable between patients with tricuspid vs bicuspid aortic valves
The likelihood of postprocedural peacemaker implantation (PMI) and midterm mortality after transcatheter aortic valve implantation (TAVI) is comparable between patients with bicuspid (B-AV) and tricuspid (T-AV) aortic valves, reports a recent meta-analysis.
Researchers accessed the databases of Medline and Embase for studies that compared B-AV and T-AV patients who underwent TAVI. Outcomes included the incidence of postprocedural PMI or transcatheter valve regurgitation (TVR), and early (30-day and in-hospital) or late mortality.
Applying the selection criteria yielded 12 eligible studies with 1,045 B-AV and 4,069 T-AV participants. Compared with T-AV patients, those with B-AV were significantly more likely to develop TVR after TAVI (risk ratio [RR], 1.42, 95 percent CI, 1.11–1.82; Z, 2.76; p=0.006). There was no significant heterogeneity of evidence (p=1.00).
In contrast, the B-AV and T-AV groups were comparable in terms of PMI incidence (RR, 1.07, 0.87–1.32; Z, 0.61; p=0.54), 30-day mortality (RR, 1.35, 0.94–1.93; Z, 1.61; p=0.11) and midterm mortality (1–2-years; RR, 1.00, 0.77–1.31; Z, 0.01; p=0.99).
The researchers then performed meta-regression analysis of six potential confounders: age, B-AV type, mean aortic valve gradient, left ventricular ejection fraction, aortic valve area and aortic valve calcification. All obtained coefficients failed to reach statistical significance, indicating that the effect of B-AV on the outcomes of interest is independent of these confounding factors.
Future meta-analyses that include a larger number of studies of good quality will be helpful in validating the present findings, the researchers said.