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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and

Francesco Cannata1,2, Mauro Chiarito1,2, Giuseppe Pinto1,2

  • 1Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele-Milan, Italy.

ESC Heart Failure
|June 30, 2022
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) significantly lowers mortality in patients with aortic stenosis and cardiac amyloidosis (CA-AS) compared to medical therapy. TAVR demonstrates comparable safety to aortic stenosis (AS) alone, with a slight increase in pacemaker implantation risk.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Aortic stenosis (AS) and cardiac amyloidosis (CA) are prevalent in the elderly.
  • Up to 16% of severe AS patients undergoing TAVR have concomitant CA, a condition associated with poorer outcomes.
  • The efficacy and safety of TAVR in CA-AS patients require comprehensive synthesis.

Approach:

  • Systematic review and meta-analysis of seven observational studies.
  • Evaluated mortality of TAVR versus medical therapy in CA-AS patients.
  • Compared complications and clinical outcomes of TAVR in CA-AS versus AS alone.

Key Points:

  • TAVR significantly reduced mortality in CA-AS patients compared to medical therapy (OR 0.23, P=0.001).
  • TAVR safety in CA-AS is comparable to AS alone regarding stroke, bleeding, and acute kidney injury.
  • A trend towards increased permanent pacemaker implantation was observed in CA-AS patients (OR 1.76, P=0.085).

Conclusions:

  • TAVR is an effective and safe treatment for CA-AS patients.
  • TAVR offers a substantial survival benefit over medical therapy for CA-AS.
  • While generally safe, TAVR in CA-AS may necessitate consideration of higher pacemaker implantation rates.
Abstract

Keywords:
Aortic stenosisCardiac amyloidosisLight-chain amyloidosisTranscatheter aortic valve replacementTransthyretin amyloidosis

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