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Outcomes of infective endocarditis after transcatheter aortic valve implantation versus aortic valve replacement surgery: a systematic review and meta-analysis
Session:
Sessão de Posters 08 - Intervenção estrutural: TAVI
Speaker:
José Carlos Pires Ferreira
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
José Carlos Pires Ferreira; Gonçalo Costa; Lino Gonçalves; Rogério Teixeira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Introduction</span></strong><span style="font-family:"Times New Roman",serif">: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) is a rare but life-threatening complication. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Objective</span></strong><span style="font-family:"Times New Roman",serif">: To assess the comparative risk of IE between TAVI and SAVR.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods</span></strong><span style="font-family:"Times New Roman",serif">: We performed a systematic searched Pubmed, Embase and Cochrane database, between July and August 2023, to identify observational and interventional studies that reported the event rate of IE in both TAVI and SAVR. A Mantel-Haenszel method and a random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Results</span></strong><span style="font-family:"Times New Roman",serif">: Forty-two studies were included in which seventeen were randomised clinical trials. A total of 172752 patients were included, providing 4079 pooled infective endocarditis events (865 in TAVI and 3214 in SAVR), resulting in an incidence of 2% and 2,5% in TAVI and SAVR, respectively. Our meta-analysis revealed a lower incidence of IE in TAVI patients compared to SAVR (pooled odds ratio [OR], 0.74; 95% confidence interval [CI] 0.60, 0.92, P < 0.01; I² = 64%). However, sub-analysis of randomized controlled trials showed no significant difference between TAVI and SAVR. Sub-analysis of surgical risk revealed no significant difference across the surgical risk (low, intermediate, and high), but a trend was noted favouring TAVI in high surgical risk (pooled OR 0.55; 95% CI [0.28, 1.11], P = 0.09, I² = 50%). Studies reporting IE at 1 year follow-up did not show difference between TAVI and SAVR (pooled OR 0.85; 95% CI [0.59, 1.23], P = 0.40, I² = 0%), as well at 5-year follow-up SAVR (pooled OR 0.76; 95% CI [0.41, 1.41], P = 0.38, I² = 78%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusion</span></strong><span style="font-family:"Times New Roman",serif">: The results of this systematic review and meta-analysis suggests a lower incidence of IE in TAVI compared to SAVR, with no significant difference in randomized controlled trials. These findings possibly highlight discrepancy between real world experience and clinical trials.</span></span></span></p> <p style="text-align:justify"> </p>
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