One-year mortality in patients with pulmonary hypertension undergoing TAVI: a systematic review and descriptive meta-analysis
Haytham Emara, Nadia Emara, Aigerim Sadykova, Ali Hammoud, Shady EmaraAbstract
Background
Pulmonary hypertension (PH) is a frequent comorbidity in severe aortic stenosis (AS) and is associated with poorer outcomes following transcatheter aortic valve implantation (TAVI). This study aims to provide a descriptive synthesis of 1-year allcause mortality rates among TAVI recipients with pre-existing PH.
Objectives
To characterise 1-year all-cause mortality rates in patients with PH undergoing TAVI, to assess the impact of study quality on reported mortality and to explore sources of heterogeneity in reported outcomes.
Design
Systematic review and descriptive meta-analysis.
Data Sources
MEDLINE, Embase, Scopus, Web of Science and Cochrane CENTRAL were searched from inception to 18 September 2024, without language restrictions.
Eligibility Criteria
Observational cohorts reporting ≥1-year mortality after TAVI in patients with PH defined by echocardiography or right-heart catheterisation. Systematic reviews were included for qualitative synthesis only.
Data Extraction and Synthesis
Two reviewers independently extracted the data and assessed the quality (Newcastle–Ottawa Scale [NOS]). A random-effects meta-analysis with logit transformation was used to pool 1-year mortality estimates from observational cohorts. Heterogeneity was quantified by I 2 ; subgroup and sensitivity analyses were performed, stratified by study quality and PH definition.
Results
Eleven observational cohorts ( N = 10,665 patients) were included in the quantitative synthesis. Pooled 1-year mortality was 24.5% (95% CI 20.0%–29.6%; I 2 = 96.7%). High-quality studies (NOS ≥ 8) showed 23.7%, while moderate-quality (NOS 6–7) showed 26.2%. Substantial heterogeneity was observed, influenced by variations in PH definition and measurement modality. Systematic reviews ( n = 6) provided additional qualitative context on the association between PH and TAVI outcomes.
Conclusions
Patients with PH undergoing TAVI exhibit high 1-year mortality rates, with approximately one in four dying within a year. Marked heterogeneity underscores differences in PH definitions and measurement. Standardised PH assessment and righ theart phenotyping are essential for improved risk stratification and patient selection, and to enable more robust prognostic studies in the future.