ABSTRACT
Background:
Aortic stenosis (AS) is the world's most prevalent
heart valve disease.
Transcatheter aortic valve replacement (TAVR) or Implantation (TAVI) is widely available yet adopting this
procedure in
Asia has been slow due to high
device cost, the need for specific
training programs, and the lack of specialized
heart teams and dedicated infrastructures. The limited number of randomized controlled trials describing TAVI outcomes among the
Asian population hampered the approval for medical reimbursements as well as acceptance among
surgeons and
operators in some
Asian countries.
Methods:
A comprehensive medical
literature search on TAVI and/or TAVR performed in
Asian countries published between January 2015 and June 2022 was done through
MEDLINE and manual searches of bibliographies. The full text of eligible articles was obtained and evaluated for final
analysis. The event rates for key
efficacy and
safety outcomes were calculated using the data from the
registries and randomized controlled trials.
Results:
A total of 15,297
patients were included from 20 eligible studies. The mean
patient age was 82.88 ± 9.94 years, with over half being
females (62.01%). All but one study reported Society of Thoracic
Surgeons (STS) scores averaging an intermediate
risk score of 6.28 ± 1.06%. The mean logistic European Systems for Cardiac Operations
Risk Evaluation (EuroSCORE) was 14.85. The mean baseline transaortic gradient and mean
aortic valve area were 50.93 ± 3.70 mmHg and 0.64 ± 0.07 cm 2 , respectively. The mean procedural success rate was 95.28 ± 1.51%. The weighted mean 30-day and 1-year all-cause mortality rate was 1.66 ± 1.21% and 8.79 ± 2.3%, respectively. The mean average for
stroke was 1.98 ± 1.49%. The
acute kidney injury (AKI) rate was 6.88 ± 5.71%. The overall major vascular complication rate was 2.58 ± 2.54%; the overall major
bleeding rate was 3.88 ± 3.74%. Paravalvular
aortic regurgitation rate was 15.07 ± 9.58%. The overall rate of pacemaker insertion was 7.76 ± 4.6%.
Conclusions:
Compared to Americans and
Europeans,
Asian patients who underwent TAVI had lower all-cause
mortality,
bleeding, and vascular
complications, however, had a higher rate of postprocedural
aortic regurgitation. More studies with greater
sample sizes are needed among
Asian patients for a more robust comparison.
