Transcatheter Aortic Valve Replacement in the Immunocompromised: A Systematic Review and Meta-Analysis

Data on the safety and efficacy of transcatheter aortic valve replacement (TAVR) for the treatment of aortic valve stenosis in immunocompromised (IC) patients is scarce, while it represents a valid alternative to surgical AVR in this vulnerable population. This meta-analysis aims to compare the clinical outcomes of TAVR in IC versus non-IC patients. A comprehensive search was conducted across PubMed, EMBASE, and Cochrane Central for randomized controlled trials and observational studies that compared outcomes between IC and non-IC patients undergoing TAVR. Primary outcomes included 1-year all-cause, cardiovascular (CV) and non-CV mortality. Secondary outcomes included new permanent pacemaker implantation (PPI) and major periprocedural complications. 4,478 patients in 7 studies (mean age 80.5 years, 7.64% IC) were included in the analysis. As compared with non-IC patients, IC patients exhibited a similar 30-day death rate (Odds Ratio [OR] 1.62; 95% Confidence Interval [CI] 0.68 to 3.98; p = 0.297), but significantly higher 1-year all-cause mortality (OR 2.39; 95% CI 1.55 to 3.70; p <0.001). Notably, IC patients demonstrated a lower risk of CV death (OR 0.24; 95% CI 0.10 to 0.59; p = 0.002) but a higher risk of non-CV death (OR 4.16; 95% CI 1.70 to 10.18; p = 0.002). There was no difference in the rate of new PPI or major periprocedural complications. In conclusion, TAVR is a safe and effective treatment strategy in IC patients, with similar short-term mortality and increased medium-term mortality risk as compared with non-IC patients. (PROSPERO: CRD42024623229).