A meta-analysis of impact of mitral stenosis on outcomes after transcatheter aortic valve implantation.

OBJECTIVES

To determine whether concomitant mitral stenosis (MS) impairs outcomes after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence.

METHODS

To identify all observational comparative studies of outcomes after TAVI for AS in patients with MS vs patients with no-MS, we searched databases (MEDLINE and EMBASE) using web-based search engines (PubMed and OVID). Studies meeting the following criteria were included; the design was an observational study; the study population was patients undergoing TAVI for AS; outcomes in patients with MS were compared with those in patients with no-MS. Study-specific estimates were then pooled using inverse variance-weighted averages of logarithmic odds and hazard ratios in the random-effects model.

RESULTS

We identified six eligible studies including 111 621 patients undergoing TAVI. In pooled analyses, postprocedural incidence of ≥ moderate paravalvular aortic regurgitation (PAR) (P = .02), early all-cause mortality (P = .008), early incidence of myocardial infarction (MI) (P = .01), and midterm all-cause mortality (P = .03) after TAVI were significantly higher in patients with MS than in patients with no-MS. There were no significant differences in early incidence of stroke, major bleeding, acute kidney injury, and new permanent pacemaker implantation after TAVI between patients with MS and patients with no-MS. When the study for mitral annular calcification was excluded in the pooled analyses, no results except for MI were substantially altered but the significance for early incidence of MI disappeared (P = .10).

CONCLUSION

Postprocedural incidence of ≥ moderate PAR, early all-cause mortality, early incidence of MI, and midterm all-cause mortality after TAVI are higher in patients with MS than in patients with no-MS.