Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis

Mojoli, Marco; Gersh, Bernard J.; Barioli, Alberto; Masiero, Giulia; Tellaroli, Paola; D’Amico, Gianpiero; Tarantini, Giuseppe

doi:10.1016/j.ahj.2017.07.005

Cited by 54 publications

(42 citation statements)

References 32 publications

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“…18 A meta-analysis of 11 studies including 11,033 patients revealed a 2.7-or 2.9-fold increased shortterm mortality of patients with preexisting or new-onset AF after TAVR. 19 In the PARTNER trial, new-onset AF but not preexisting AF was associated with increased mortality after 30 days. 20 In contrast, a very recent analysis of 72,660 patient Medicare records demonstrated increased 30-day mortality in patients with preexisting but not new-onset AF.…”

Section: Discussionmentioning

confidence: 99%

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

et al. 2020

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Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

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Section: Discussionmentioning

confidence: 99%

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

et al. 2020

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“…In contrast to prior meta-analyses, we concluded that patients with MR exhibit significant baseline differences compared to controls, which may independently impact mortality. In a meta-analysis of 11 studies (n > 11,000 patients), the presence of atrial fibrillation was associated with a higher short-and long-term mortality in patients undergoing TAVI [18]. Similarly, a lower LVEF and a higher STS score were associated with a higher mortality following TAVI [19,20].…”

Section: Discussionmentioning

confidence: 99%

Does the Presence of Significant Mitral Regurgitation prior to Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact Mortality? – Meta-Analysis and Systematic Review

et al. 2020

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Background: Mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis (AS). However, its independent impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established. Methods: We performed a systematic search for studies reporting characteristics and outcome of patients with and without significant MR and/or adjusted mortality associated with MR post-TAVI. We conducted a meta-analysis of quantitative data. Results: Seventeen studies with 20,717 patients compared outcomes and group characteristics. Twenty-one studies with 32,257 patients reported adjusted odds of mortality associated with MR. Patients with MR were older, had a higher Society of Thoracic Surgeons score, lower left ventricular ejection fraction, a higher incidence of prior myocardial infarction, atrial fibrillation, and a trend towards higher NYHA class III/IV, but had similar mean gradient, gender, and chronic kidney disease. The MR patients had a higher unadjusted short-term (RR =

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“…Furthermore, in patients with AF, VKA is indicated, as it is more effective than single antiplatelet therapy (SAPT) and DAPT regarding primary stroke prevention with an acceptable risk of bleeding. 8 , 33 , 40 – 42 However, currently available studies, limited by their underpowered and mainly observational natures, have not elucidated whether OAC monotherapy [that is, a VKA or a direct-acting oral anticoagulant (DOAC)] or APT in addition to an OAC after TAVR is more appropriate. Nicolas et al .…”

Section: Anticoagulant Therapymentioning

confidence: 99%

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Zeng

Cheng

Xia

et al. 2020

Therapeutic Advances in Chronic Disease

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Atrial fibrillation (AF) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Depending on the timing of AF detection, it is usually categorized as pre-existing AF or new-onset AF. Antiplatelet therapy, rather than a vitamin K antagonist, may be considered as the primary treatment for patients without an indication for oral anticoagulants who undergo TAVR. However, the optimal postprocedural antithrombotic regimen for patients with AF undergoing TAVR remains unknown. In this review, we briefly introduce the management strategies of antithrombotic therapy and list the evidence from related studies to elucidate the optimal antithrombotic management for patients with AF undergoing TAVR.

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Impact of atrial fibrillation on outcomes of patients treated by transcatheter aortic valve implantation: A systematic review and meta-analysis

Cited by 54 publications

References 32 publications

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

Does the Presence of Significant Mitral Regurgitation prior to Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact Mortality? – Meta-Analysis and Systematic Review

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

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