Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.

Autor:	Sattar Y; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Hamza M; Department of Internal Medicine, Albany Medical Center Albany, NY 12208, USA., Yasmin F; Yale School of Medicine New Haven, CT 06519, USA., Jabeen S; Liaquat National Hospital and Medical College Karachi 74800, Pakistan., Patel N; Department of Internal Medicine, New York Medical College/Landmark Medical Center Woonsocket, RI 02895, USA., Ishaq S; Sinai Hospital of Baltimore, Life Bridge Health Baltimore, MD 21215, USA., Alyami B; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Ul Hussain H; Department of Internal Medicine, Dow University of Health Sciences Karachi 74200, Pakistan., Rehan ST; Department of Internal Medicine, Dow University of Health Sciences Karachi 74200, Pakistan., Shuja SH; Department of Internal Medicine, Dow University of Health Sciences Karachi 74200, Pakistan., Khan Z; Department of Internal Medicine, Dow University of Health Sciences Karachi 74200, Pakistan., Bahar Y; Wayne State University Detroit, MI 48201, USA., Elgendy IY; University of Kentucky Lexington, KY 40506, USA., Gonuguntla K; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Thyagaturu H; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Kawsara A; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Felpel K; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Daggubati R; Department of Cardiology, West Virginia University Morgantown, WV 26506, USA., Alraies MC; Detroit Medical Center/Wayne State University Detroit, MI 48201, USA.
Jazyk:	angličtina
Zdroj:	American journal of cardiovascular disease [Am J Cardiovasc Dis] 2024 Apr 15; Vol. 14 (2), pp. 54-69. Date of Electronic Publication: 2024 Apr 15 (Print Publication: 2024).
DOI:	10.62347/PORE5631
Abstrakt:	Background: Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR. Methods: We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software. Results: A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group. Conclusion: Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings. Competing Interests: None. (AJCD Copyright © 2024.)
Databáze:	MEDLINE
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