Transcatheter Aortic Valve Replacement in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• The co-existence of severe aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) presents a complex clinical challenge.
• While surgical intervention is standard, transcatheter aortic valve replacement (TAVR) is an option for high-risk patients.
• Outcomes of TAVR in patients with concomitant HCM remain incompletely understood.

Purpose of the Study:

• To investigate the impact of hypertrophic cardiomyopathy (HCM) on the outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS).

Main Methods:

• A systematic literature search was conducted across PubMed, EMBASE, and Scopus.
• Included studies compared TAVR outcomes between patients with and without underlying HCM.
• A random-effects model was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Main Results:

• Three observational cohort studies were identified, comparing TAVR in AS patients with and without HCM.
• TAVR in patients with co-existing HCM was associated with significantly higher rates of mortality (OR 5.79), cardiogenic shock (OR 4.55), aortic dissection (OR 4.95), vascular complications (OR 2.10), and renal impairment (OR 1.80).
• No significant differences were observed in complete heart block, new permanent pacemaker implantation, or bleeding events.

Conclusions:

• Transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) is associated with substantially increased risks of mortality, cardiogenic shock, aortic dissection, vascular complications, and renal impairment.
• These findings underscore the heightened risks and necessitate careful consideration when electing TAVR in this specific patient population.