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Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve with Aortic Stenosis: a Meta-Analysis and Trial Sequential Analysis
Chan, Jeffrey Shi Kai; Singh, Sukhdeep; Eriksen, Peter; Tsui, Lok Him; Harky, Amer; for the Cardiovascular Evidence Review Collaboration (CvERC).
  • Chan, Jeffrey Shi Kai; Prince of Wales Hospital. Department of Medicine and Therapeutics. Division of Cardiology. HK
  • Singh, Sukhdeep; The Chinese University of Hong Kong. Faculty of Medicine. HK
  • Eriksen, Peter; University of Liverpool. School of Medicine. Liverpool. GB
  • Tsui, Lok Him; The University of Hong Kong. Li Ka Shing Faculty of Medicine. HK
  • Harky, Amer; Liverpool Heart and Chest Hospital. Department of Cardiothoracic Surgery. GB
Rev. bras. cir. cardiovasc ; 37(1): 88-98, Jan.-Feb. 2022. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1365530
ABSTRACT
Abstract

Objectives:

Bicuspid aortic valve (BAV) is an important aetiology of aortic stenosis and the use of transcatheter aortic valve implantation (TAVI) has not been fully explored in this cohort. This systematic review and meta-analysis compared the outcomes of TAVI in stenotic BAV against tricuspid aortic valve (TAV).

Methods:

An electronic literature search was performed in PubMed, MEDLINE, EMBASE, and Scopus to identify all studies comparing TAVI in stenotic BAV versus TAV. Only studies comparing TAVI in BAV versus TAV were included, without any limit on the study date. Primary endpoints were 30-day and 1-year mortality, while secondary endpoints were postoperative rates of stroke, acute kidney injury (AKI), and permanent pacemaker (PPM) requirement. A trial sequential analysis (TSA) was performed for all endpoints to understand their significance.

Results:

Thirteen studies met the inclusion criteria (917 BAV and 3079 TAV patients). The BAV cohort was younger (76.8±7.43 years vs. 78.5±7.12 years, P=0.02), had a higher trans-aortic valve gradient (P=0.02), and larger ascending aortic diameters (P<0.0001). No significant difference was shown for primary (30-day mortality [P=0.45] and 1-year mortality [P=0.41]) and secondary endpoints (postoperative stroke [P=0.49], AKI [P=0.14], and PPM requirement [P=0.86]). The BAV group had a higher rate of significant postoperative aortic regurgitation (P=0.002). TSA showed that there was sufficient evidence to conclude the lack of difference in PPM requirements, and 30-day and 1-year mortality between the two cohorts.

Conclusion:

TAVI gives satisfactory outcomes for treating stenotic BAV and should be considered clinically.


Texto completo: Disponible Índice: LILACS (Américas) Tipo de estudio: Estudio pronóstico / Revisiones Sistemáticas Evaluadas Idioma: Inglés Revista: Rev. bras. cir. cardiovasc Asunto de la revista: Cardiología / Cirugía General Año: 2022 Tipo del documento: Artículo País de afiliación: China / Hong Kong / Reino Unido Institución/País de afiliación: Liverpool Heart and Chest Hospital/GB / Prince of Wales Hospital/HK / The Chinese University of Hong Kong/HK / The University of Hong Kong/HK / University of Liverpool/GB

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Texto completo: Disponible Índice: LILACS (Américas) Tipo de estudio: Estudio pronóstico / Revisiones Sistemáticas Evaluadas Idioma: Inglés Revista: Rev. bras. cir. cardiovasc Asunto de la revista: Cardiología / Cirugía General Año: 2022 Tipo del documento: Artículo País de afiliación: China / Hong Kong / Reino Unido Institución/País de afiliación: Liverpool Heart and Chest Hospital/GB / Prince of Wales Hospital/HK / The Chinese University of Hong Kong/HK / The University of Hong Kong/HK / University of Liverpool/GB