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The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic

Maximilian Will1,2, Konstantin Schwarz1, Thomas Weiss2,3

  • 1Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 21, 2023
PubMed

Insights

Chronic total occlusions (CTOs) are common in patients undergoing transcatheter aortic valve replacement (TAVR). While CTOs increase in-hospital complications, they do not appear to significantly raise long-term mortality risk in TAVR patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) is prevalent in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
  • The prognostic impact of coronary chronic total occlusions (CTOs) in TAVR patients remains unclear.

Approach:

  • A systematic literature search of MEDLINE and EMBASE was performed to identify relevant studies.
  • Pooled analysis of four studies involving 25,432 patients was conducted to assess outcomes in TAVR patients with and without CTOs.
  • Mortality rates and risk ratios were estimated to evaluate the prognostic relevance of CTOs.

Key Points:

  • The prevalence of CTOs in TAVR patients ranged from 2% to 12.6%.
  • CTOs were associated with increased length of stay, cardiogenic shock, acute myocardial infarction, and acute kidney injury.
  • A meta-analysis showed a nonsignificant trend toward increased 1-year mortality in patients with CTOs (RR 1.11, 95% CI 0.90-1.40).

Conclusions:

  • Concomitant CTOs are frequently observed in TAVR patients and are linked to higher in-hospital complication rates.
  • CTO presence alone did not significantly increase long-term mortality after TAVR.
  • Further research is needed to fully elucidate the prognostic significance of CTOs in the TAVR population.

Keywords:
aortic stenosis (AS)chronic total occlusion (CTO)coronary artery disease (CAD)percutaneous coronary intervention (PCI)trans aortic valve replacement (TAVR)

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