Transcatheter Aortic Valve Implantation in Cardiac Amyloidosis and Aortic Stenosis

https://doi.org/10.1016/j.amjcard.2023.04.003Get rights and content

Aortic stenosis (AS) and cardiac amyloidosis (CA) occur concomitantly in a significant number of patients and portend a higher risk of all-cause mortality. Previous studies have investigated outcomes in patients with concomitant CA/AS who underwent transcatheter aortic valve implantation (TAVI) versus medical therapy alone, but no evidence-based consensus regarding the ideal management of these patients has been established. Medline, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Methodologic bias was assessed using the modified Newcastle-Ottawa scale for observational studies. A total of 4 observational studies comprising 83 patients were included. Of these, 45 patients (54%) underwent TAVI, whereas 38 (46%) were managed conservatively. Of the 3 studies that included baseline characteristics by treatment group, 30% were women. The risk of all-cause mortality was found to be significantly lower in patients who underwent TAVI than those treated with conservative medical therapy alone (odds ratio 0.24, 95% confidence interval 0.08 to 0.73). In conclusion, this meta-analysis suggests a lower risk of all-cause mortality in patients with CA with AS who underwent TAVI than those managed with medical therapy alone.

Section snippets

Methods

This systematic review and meta-analysis was conducted and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.9 Medline, Scopus, and Cochrane Central Register of Controlled Trials were searched from database inception through February 2022, using the following combination of keywords: (aortic stenosis OR aortic valvulopathy OR AS) AND (cardiac amyloidosis OR transthyretin amyloidosis OR amyloidosis) AND (transcatheter aortic valve replacement

Results

The literature search yielded 377 articles; 4 observational studies involving 83 patients were included (Figure 1). The characteristics of the included studies are summarized in Table 1. The general demographics and baseline characteristics of patients is listed in Table 2.

Of the 83 patients, 45 underwent TAVI (54%), and 38 received conservative medical management without undergoing TAVI (46%). AS was classified as severe in 80 of 83 patients (96%). In the 3 studies that presented patient

Discussion

This meta-analysis demonstrates improved survival in patients with concomitant moderate-to-severe AS and CA who underwent TAVI compared with medical therapy alone (Figure 3). This study suggests that TAVI in patients with CA/AS is associated with lower mortality than medical therapy alone.

CA is a complicating co-morbidity for a significant proportion of patients with AS who underwent TAVI. Recent studies have suggested that the prevalence of CA in patients with AS is much higher than previously

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this was a meta-analysis, this study did not require approval by our institutional review board. This article does not contain any studies with animals performed by any of the authors.

Disclosures

The authors have no conflicts of interest to declare.

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  • Drs. Riley and Junarta contributed equally as co-first authors.

    Funding: none.

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