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Transcatheter Aortic Valve Implantation in Cardiac Amyloidosis and Aortic Stenosis

Joshua M Riley1, Joey Junarta1, Waqas Ullah2

  • 1Department of Medicine, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.

The American Journal of Cardiology
|May 14, 2023
PubMed

Insights

Transcatheter aortic valve implantation (TAVI) significantly reduces mortality risk in patients with aortic stenosis and cardiac amyloidosis compared to conservative medical therapy alone.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Interventional Cardiology

Background:

  • Aortic stenosis (AS) and cardiac amyloidosis (CA) frequently coexist, increasing mortality risk.
  • Optimal management for concomitant CA/AS remains undefined, with limited comparative outcome data.

Purpose of the Study:

  • To systematically review and meta-analyze existing evidence on management strategies for patients with concomitant cardiac amyloidosis and aortic stenosis.
  • To compare the all-cause mortality risk between transcatheter aortic valve implantation (TAVI) and conservative medical therapy.

Main Methods:

  • Systematic literature search of Medline, Scopus, and Cochrane Central Register of Controlled Trials.
  • Inclusion of 4 observational studies with 83 patients (45 TAVI, 38 conservative).
  • Assessment of methodologic bias using the modified Newcastle-Ottawa scale.

Main Results:

  • Patients undergoing TAVI demonstrated a significantly lower risk of all-cause mortality (OR 0.24, 95% CI 0.08-0.73).
  • TAVI was performed in 54% of patients, while 46% received conservative management.
  • Women comprised 30% of the study population across 3 studies with baseline data.

Conclusions:

  • This meta-analysis suggests TAVI is associated with reduced all-cause mortality in patients with concomitant CA and AS.
  • Transcatheter aortic valve implantation may offer a survival benefit over conservative medical therapy for this high-risk patient group.

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