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Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Med Sci Monit. 2019 Sep 27;25:7251-7257 doi: 10.12659/MSM.916185.
PICO Summary
POPULATION:

Patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=6,046, 6 studies).

INTERVENTION:

Patients with pre-operative anaemia (defined as a hemoglobin level of <12 g/dl for women and hemoglobin of <13 g/dl in men).

COMPARISON:

Patients without pre-operative anaemia.

OUTCOME:

There was no significant difference observed for the final pooled result for patients with and without anaemia for short-term 30-day postoperative mortality. However, long-term mortality rates were significantly worse in patients with preoperative anaemia compared with those without anaemia.

Abstract

BACKGROUND Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. MATERIAL AND METHODS PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. RESULTS Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). CONCLUSIONS Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.

Metadata
MESH HEADINGS: Anemia; Aortic Valve Stenosis; Comorbidity; Female; Humans; Male; Odds Ratio; Postoperative Period; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
Study Details
Study Design: Systematic Review
Language: eng
Credits: Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine