Direct Comparison of Urgent Transcatheter Aortic Valve Implantation and Balloon Aortic Valvuloplasty: A Systematic Review and Meta-Analysis.

Abstract

Objective: Aortic stenosis (AS) may complicate cardiogenic shock (CS) or acute decompensated heart failure (ADHF) in a small but significant number of patients. In such cases, urgent treatment is necessary to prevent mortality and adverse outcomes. Transcatheter aortic valve implantation (TAVI) and balloon aortic valvuloplasty (BAV) represent the main treatment options, however, limited studies have compared them directly. Therefore, this systematic review and meta-analysis aims to synthesize available studies directly comparing urgent TAVI and BAV, in respect to reported outcomes.

Methods: We systematically searched MEDLINE/PubMed, Scopus and Web of Science for studies comparing outcomes in patients with CS or ADHF undergoing urgent TAVI or BAV. Followingly, a meta-analysis of all included studies was performed.

Results: A total of six studies, including 21,020 patients (10,597 patients undergoing TAVI and 10,423 patients undergoing BAV) were analyzed. Regarding in-hospital mortality, it was found to be significantly lower in patients undergoing urgent TAVI, compared to BAV (risk ratio [RR]: 0.53; 95% confidence interval (CI): 0.32-0.87]. Moreover, urgent TAVI was also associated with significantly lower all-cause mortality at 30-days follow up (RR 0.51, 95% CI: 0.31-0.84).

Conclusion: In this meta-analysis of observational, retrospective studies including patients undergoing urgent transcatheter interventions for acute AS, TAVI is associated with significantly reduced in-hospital and 30-days mortality, in comparison to BAV. More larger studies, reporting extended follow-up and adverse events' rates, are needed to safely conclude regarding the benefit of urgent interventions in the acute care.