Early and Late Outcomes of Transcatheter Aortic Valve Replacement in Patients With Prior Chest Radiation: A Systematic Review and Meta-Analysis.

Background: Patients with prior history of chest or mediastinal radiation are deemed high risk for surgical AVR. Transcatheter aortic valve replacement (TAVR) has emerged as a promising alternative for these patients, however, this patient population was underrepresented in prior TAVR trials.

Aims: To compare the outcomes of TAVR in patients with versus without a history of prior chest or mediastinal radiation.

Methods: This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic search of electronic databases was conducted up to September 2023. We compared early and late mortality as well as complications. A meta-analysis was conducted with the use of a random effects model. The I-square statistic was used to assess heterogeneity.

Results: Seven studies comprising 6358 patients were included in this meta-analysis. Patients undergoing TAVR in the radiation group had a higher risk for heart failure exacerbation (OR: 2.06; 95% CI: 1.18-3.59) and aortic valve reintervention (OR: 5.68; 95% CI: 1.83-17.67) in the early postoperative period compared to the nonradiation group. Analysis revealed similar short-term (in-hospital or 30-day) all-cause-mortality (OR: 1.63; 95% CI: 0.89-2.98) between the two groups. Other perioperative complications including myocardial infarction (MI), stroke, pacemaker insertion requirement, major bleeding as well as access-related complications were not significantly different between the two groups. TAVR in the radiation group was not associated with increased all-cause mortality compared to the nonradiation group (OR: 1.40; 95% CI: 0.93-2.11) after a mean follow-up of 17.6 months. Other endpoints including MI, stroke, need for pacemaker insertion, heart failure readmission rate, and need for aortic valve reintervention were similar in the mid-term follow-up between the two groups.

Conclusion: TAVR in patients with a history of prior chest or mediastinal radiation was associated with similar short-term and mid-term mortality compared to patients without radiation. The history of chest or mediastinal radiation was associated with more frequent heart failure hospitalizations and aortic valve reintervention in the postoperative period. No difference was found in mid-term complications. Future studies are warranted to validate our findings.