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Outcomes of transcatheter aortic valve implantation in young low-risk patients: a comprehensive meta-analysis of efficacy and safety.
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Antonio Maria Rocha de Almeida
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
António Maria Rocha De Almeida; Maria Rita Lima; Daniel Gomes; Renato Fernandes; Eduardo Infante Oliveira; Pedro Araújo Gonçalves; Rui Campante Teles; Manuel Almeida; Lino Patrício
Abstract
<p><strong>Introduction</strong></p> <p>Severe aortic stenosis (AS) was traditionally managed with surgical aortic valve replacement (SAVR). Transcatheter aortic valve implantation (TAVI) emerged as a less invasive alternative, originally for high-risk patients. Its use expanded to intermediate- and low-risk older patients based on promising results. This meta-analysis evaluates TAVI's outcomes in younger, low-risk patients, where SAVR is currently the gold standard.</p> <p><strong>Methods</strong></p> <p>Following PRISMA guidelines, we systematically searched randomized controlled trials (RCTs) comparing TAVI with SAVR in young (i.e. mean age <75 years) low-risk patients (i.e. STS score <4%) with severe symptomatic AS. The primary endpoint was a composite of death or disabling stroke. Secondary endpoints included all-cause mortality, disabling stroke, atrial fibrillation (AF), permanent pacemaker implantation (PPI), bleeding, functional class (NYHA), and quality of life (KCCQ score) improvements and prosthesis-related outcomes.</p> <p><strong>Results</strong></p> <p>Four RCTs were included with 4252 patients (2125 TAVI and 2127 SAVR). At a mean follow-up of 16±5 months, TAVI had a non-significantly lower incidence of death or disabling stroke (2.8% vs. 5.1% logRR 0.02 [0.00-0.04] p=0.11), and all-cause mortality (2.1% vs. 3.7%, logRR 0.01 [0.00-0.03] p=0.15). Disabling stroke was significantly lower in the TAVI group (0.9 vs. 2.1 logRR 0.01[0.00-0.02] p<0.01). Hospital readmission (7.1% vs. 9.5% logRR 0.03 [0.01-0.04] p<0.01), and bleeding rates (4.7% vs. 16%, logRR 0.14 [0.07-0.20] p<0.01) were significantly lower in the TAVI group. On the other hand, TAVI had a higher PPI rate (14% vs. 6%, logRR -0.08 [-0.13; -0.02], p<0,01) and significant paravalvular leak (2,5% vs. 0,5% logRR -0,02 95%CI [-0,04; -0,00] p<0,01 I2=77%). There were no statistically significant differences in the other prosthesis-related outcomes between both groups. Faster symptomatic and quality of life improvements were sustained in the TAVI group.</p> <p><strong>Conclusion</strong></p> <p>TAVI is a viable option for young low-risk patients with severe AS, being non-inferior to SAVR in all short-term outcomes. The benefits of TAVI included a lower risk of disabling strokes, reduced rates of readmission and bleeding, and faster and sustained improvements in symptoms and quality of life. The higher PPI and paravalvular leak rates in the TAVI group highlight the need for careful patient selection.</p>
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