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Midterm Survival Of Patients Undergoing Tavr For Mixed Aortic Valve Disease Versus Isolated Aortic Stenosis: Results From Over 7000 Patients
Nav Warraich, Danial Ahmad, James A. Brown, Derek Serna-Gallegos, Dustin Kliner, Catalin Toma, Amber Makani, Irsa Hasan, Takuya Ogami, Johannes Bonatti, Ibrahim Sultan.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
BACKGROUND: To evaluate midterm survival outcomes of patients with mixed aortic valve disease (MAVD) versus predominant aortic stenosis undergoing transcatheter aortic valve replacement.
METHODS: This was a study-level meta-analysis of reconstructed time-to-event data for non-randomized studies published by October 2024. Electronic databases were searched for studies comparing the two populations with Kaplan-Meier data for overall survival. Individual patient data was reconstructed based on the published graphs and merged. Kaplan-Meier survival estimation and Cox proportional hazards regression was performed.
RESULTS: Ten studies (5 propensity-matched, 5 unmatched) met our inclusion criteria with a total of 7340 patients (4263 isolated aortic stenosis, 3077 MAVD). MAVD was defined as >= mild or >= moderate concomitant aortic regurgitation with severe aortic stenosis in the included studies. At 5 years follow-up, there was no significant difference in survival between patients in the aortic stenosis group and MAVD group ([hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.94-1.14, p=0.51]). Sensitivity analysis restricted to studies defining MAVD as moderate or greater concomitant aortic regurgitation (62% of the total population) also determined no survival difference between groups (HR 0.97, 95% CI 0.84-1.12, p=0.67). When including only propensity-matched studies (35% of the total population), we observed a significant reduction in survival in patients with aortic stenosis compared to MAVD (HR 0.79, 95% CI 0.65-0.94, p=0.01). Landmark analysis was performed at the 1-year time point. Up to 1-year follow-up, there was no difference between groups (HR 0.87, 95% CI 0.69-1.09, p=0.22), however, after 1 year a statistically significant difference in favor of the MAVD group was observed (HR 0.63, 95% CI 0.45-0.88, p=0.01).
CONCLUSIONS: Transcatheter aortic valve replacement is safe in patients with MAVD, with similar midterm survival as patients with predominant aortic stenosis. A survival benefit of MAVD compared to aortic stenosis is observed after 1 year in analysis restricted to propensity-matched studies.
LEGENDFigure 1. Kaplan Meier curves of overall survival along with Cox regression models
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