Outcomes of transcatheter aortic valve replacement in patients with hypertrophic cardiomyopathy: a systematic review.

BACKGROUND

Transcatheter aortic valve replacement (TAVR) is a guideline recommended minimally invasive cardiovascular procedure used to replace severely stenosis aortic valves. Patients with severe aortic stenosis (AS) and co-existing hypertrophic cardiomyopathy (HCM), a common defect affecting the left ventricle of the heart, have been excluded from TAVR studies due to perceived challenges to optimal valve implantation in this group of patients because of the hypertrophied left ventricle that can result in an abrupt drop in afterload from a newly replaced and more efficient aortic valve. This exclusion has resulted in paucity of data on this patient population. This study aims to review outcomes in patient with HCM undergoing TAVR for severe AS.

METHODS

Using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement, we performed a systematic literature search of published outcomes regarding TAVR in HCM patients to provide some insight in this patient population.

RESULTS

Our study showed that TAVR had significantly lower rates of in-hospital mortality, bleeding requiring a blood transfusion, invasive mechanical ventilation, acute kidney injury, vascular complications, and decreased length of stay (LOS) compared to surgical aortic valve replacement (SAVR) in our study population of 836 subjects from 11 publications. Our study is not a randomized controlled trial, which limits its generalization.

CONCLUSIONS

In severe AS patients with HCM, TAVR results in better outcomes compared to surgery.