Heart (British Cardiac Society) · 2026
Impact of advanced cardiac damage in severe aortic stenosis on short-term and mid-term mortality and rehospitalisation after transcatheter aortic valve implantation: a systematic review and meta-analysis.
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Baay Mohammadreza, Hosseini Zahra, Zadgari Ervin, Moayerifar Mani, Taghavi Sepideh, Sammak Salekdeh Mohammad, Amouzadeh Lichahi Mohammad, Jafari Maryam, Agajani Alireza, Firouzi Ata, Abdi Seyfollah, Khalilipur Ehsan, Alemzadeh Ansari Mohammad Javad, Elahifar Armin, Safavi Rad Amine, Gholipour Mahboobeh, Ghasemzadeh Golshan
Аннотация
BACKGROUND: Severe aortic stenosis (AS) is commonly associated with advanced cardiac damage, including right ventricular dysfunction (RVD), pulmonary hypertension (PH) and tricuspid regurgitation (TR), which may worsen prognosis after transcatheter aortic valve implantation (TAVI). This systematic review and meta-analysis aimed to assess the effect of these conditions on short-term and mid-term mortality and rehospitalisation following TAVI.
METHODS: We conducted a systematic search of PubMed, Scopus and Web of Science for studies published up to June 2025. Eligible studies included adults with AS undergoing TAVI and reported outcomes at 1 month, 6 months or 12 months stratified by the presence of RVD, PH or TR. Studies had to report either HRs, risk ratios (RRs) or sufficient raw event data for mortality or rehospitalisation. Data were synthesised using a random-effects meta-analysis. Subgroup analyses were conducted by cardiac damage severity according to the Généreux staging system and stratified by valve type and diagnostic modality. Risk of bias in included studies was assessed using the Joanna Briggs Institute's checklist for cohort studies. Meta-regression was performed to explore sources of between-study heterogeneity.
RESULTS: A total of 34 studies including 26 076 patients met inclusion criteria. Twelve-month HRs for all-cause mortality increased with advancing cardiac damage: borderline stage HR 1.61 (1.22-2.12), stage 3 HR 2.06 (1.63-2.60) and stage 4 HR 2.77 (2.11-3.64). RRs followed a similar trend. Cardiovascular mortality was highest in stage 4 (HR 3.13 (1.20-8.17); RR 2.63 (1.54-4.47)). Rehospitalisation data were limited but suggested elevated risk in stage 3 (RR 1.33 (1.12-1.58)). Meta-regression indicated that age, sex and comorbidities contributed to between-study heterogeneity, particularly in stage 3 analyses.
CONCLUSION: Extravalvular cardiac damage, especially RVD (stage 4), is strongly associated with increased short-term and mid-term mortality and rehospitalisation after TAVI. Even borderline-stage patients face elevated risk, underscoring the continuous nature of AS-related cardiac injury. Incorporating cardiac damage staging into preprocedural assessment can enhance risk stratification and guide management to improve patient outcomes.
PROSPERO REGISTRATION NUMBER: CRD420250638838.
METHODS: We conducted a systematic search of PubMed, Scopus and Web of Science for studies published up to June 2025. Eligible studies included adults with AS undergoing TAVI and reported outcomes at 1 month, 6 months or 12 months stratified by the presence of RVD, PH or TR. Studies had to report either HRs, risk ratios (RRs) or sufficient raw event data for mortality or rehospitalisation. Data were synthesised using a random-effects meta-analysis. Subgroup analyses were conducted by cardiac damage severity according to the Généreux staging system and stratified by valve type and diagnostic modality. Risk of bias in included studies was assessed using the Joanna Briggs Institute's checklist for cohort studies. Meta-regression was performed to explore sources of between-study heterogeneity.
RESULTS: A total of 34 studies including 26 076 patients met inclusion criteria. Twelve-month HRs for all-cause mortality increased with advancing cardiac damage: borderline stage HR 1.61 (1.22-2.12), stage 3 HR 2.06 (1.63-2.60) and stage 4 HR 2.77 (2.11-3.64). RRs followed a similar trend. Cardiovascular mortality was highest in stage 4 (HR 3.13 (1.20-8.17); RR 2.63 (1.54-4.47)). Rehospitalisation data were limited but suggested elevated risk in stage 3 (RR 1.33 (1.12-1.58)). Meta-regression indicated that age, sex and comorbidities contributed to between-study heterogeneity, particularly in stage 3 analyses.
CONCLUSION: Extravalvular cardiac damage, especially RVD (stage 4), is strongly associated with increased short-term and mid-term mortality and rehospitalisation after TAVI. Even borderline-stage patients face elevated risk, underscoring the continuous nature of AS-related cardiac injury. Incorporating cardiac damage staging into preprocedural assessment can enhance risk stratification and guide management to improve patient outcomes.
PROSPERO REGISTRATION NUMBER: CRD420250638838.