Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

BMC Cardiovascular Disorders

Zeyi Cheng¹  Wence Zhou²  Lin Chen³  Shiyan Tu⁴  Xing Wang⁴  Wenkai Jiang⁴  Caifei Xiang⁵ 

[1] Department of Cardiac Surgery, Ruijin Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, No.197, Ruijin Road (Second), 200025, Shanghai City, China;Department of General Surgery, The First Hospital of Lanzhou University, No. 1, Donggangxi Road, Chengguan District, 730000, Lanzhou City, Gansu Province, China;Department of Infectious Diseases, The First Hospital of Lanzhou University, No. 1, Donggangxi Road, Chengguan District, 730000, Lanzhou City, Gansu Province, China;The First Clinical Medical College of Lanzhou University, No.222, Tianshui Road (South), Chengguan District, 730000, Lanzhou City, Gansu Province, China;The Second Clinical Medical College of Lanzhou University, No.222, Tianshui Road (South), Chengguan District, 730000, Lanzhou City, Gansu Province, China;

关键词: Transcatheter aortic valve implantation;    Surgical aortic valve replacement;    Hepatic insufficiency;    Meta-analysis;    Mortality;   

DOI  :  10.1186/s12872-022-02510-2

来源: Springer

【 摘 要 】

BackgroundTranscatheter aortic valve implantation (TAVI) is currently a common treatment in high-risk aortic stenosis patients, but the impact of hepatic insufficiency on prognosis after TAVI is debatable and whether TAVI is superior to surgical aortic valve replacement (SAVR) in patients with hepatic insufficiency is uncertain.ObjectiveTo investigate the effect of abnormal liver function on the outcome and safety after TAVI and whether TAVI is superior to SAVR in patients with hepatic insufficiency.MethodsPubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception up to 26 November 2021. Studies were eligible if mortality and complications after TAVI in patients with and without hepatic insufficiency, or mortality and complications for TAVI versus SAVR in patients with hepatic insufficiency were reported. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of each study. This meta-analysis was registered with PROSPERO (CRD42021253423) and was carried out by using RevMan 5.3 and Stata 14.0.ResultsThis meta-analysis of 21 studies assessed a total of 222,694 patients. Hepatic insufficiency was associated with higher short-term (in-hospital or 30-day) mortality [OR = 1.62, 95% CI (1.18 to 2.21), P = 0.003] and 1–2 years mortality [HR = 1.64, 95% CI (1.42 to 1.89), P < 0.00001] after TAVI. Between TAVI and SAVR in patients with hepatic insufficiency, there was a statistically significant difference in in-hospital mortality [OR = 0.46, 95% CI (0.27 to 0.81), P = 0.007], the occurrence rate of blood transfusions [OR = 0.29, 95% CI (0.22 to 0.38), P < 0.00001] and the occurrence rate of acute kidney injury [OR = 0.55, 95% CI (0.33 to 0.91), P = 0.02].ConclusionsTAVI patients with hepatic insufficiency may have negative impact both on short-term (in-hospital or 30-day) and 1–2-years mortality. For patients with hepatic insufficiency, TAVI could be a better option than SAVR.

【 授权许可】

CC BY