Transcatheter versus Surgical Aortic Valve Replacement Outcomes among Solid Organ Transplant Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The safety and clinical outcomes of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) among patients with solid organ transplants (SOT) is not well understood.

OBJECTIVE: This study aimed to evaluate the clinical outcomes of TAVR and SAVR among patients with a history of solid organ transplantation.

METHOD: We performed a systematic literature search of databases for relevant articles from inception until May 1st, 2022. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.

RESULT: A total of 3240 studies were identified of which 3 studies with a total of 2960 patients were included in the final analysis. For SOT patients, the odds of in-hospital mortality (OR 0.37, 95% CI 0.20 to 0.71, p<0.001), 30-day mortality (OR 0.51, 95% CI 0.35 to 0.74, p<0.001), acute kidney injury (OR 0.45, 95% CI 0.35 to 0.59, p<0.001), and bleeding (OR 0.35, 95% CI 0.27 to 0.46, p<0.001) were significantly lower in patients undergoing TAVR compared to SAVR. In contrast, the odds of pacemaker implantation (OR 2.60, 95% CI 0.36 to 18.90, p=0.34), post-procedural stroke (OR 0.36, 95% CI 0.13 to 1.03, p=0.06) were similar between both groups of patients. Length of hospital stay was significantly lower in TAVR compared to SAVR patients (SMD -0.82, 95% CI -0.95 to -0.70, p<0.001).

CONCLUSION: In solid organ transplant patients, TAVR appeared to be a safe procedure with fewer post-procedure complications, shorter length of hospital stay, and lower in hospital mortality compared with SAVR.