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The current recommendation for bioprosthetic valve replacement in severe aortic stenosis (AS) is either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). We evaluated the performance of a machine learning-based predictive model using existing periprocedural variables for valve replacement modality selection. We analyzed 415 patients in a retrospective longitudinal cohort of adult patients undergoing aortic valve replacement for aortic stenosis. A total of 72 clinical variables including demographic data, patient comorbidities, and preoperative investigation characteristics were collected on each patient. We fit models using LASSO (least absolute shrinkage and selection operator) and decision tree techniques. The accuracy of the prediction on confusion matrix was used to assess model performance. The most predictive independent variable for valve selection by LASSO regression was frailty score. Variables that predict SAVR consisted of low frailty score (value at or below 2) and complex coronary artery diseases (DVD/TVD). Variables that predicted TAVR consisted of high frailty score (at or greater than 6), history of coronary artery bypass surgery (CABG), calcified aorta, and chronic kidney disease (CKD). The LASSO-generated predictive model achieved 98% accuracy on valve replacement modality selection from testing data. The decision tree model consisted of fewer important parameters, namely frailty score, CKD, STS score, age, and history of PCI. The most predictive factor for valve replacement selection was frailty score. The predictive models using different statistical learning methods achieved an excellent concordance predictive accuracy rate of between 93% and 98%.

This study aimed to compare incidence of IE between BE and SE valves by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to November 2019. Included studies were published observational studies that compared the risk of IE among patients undergoing TAVR employing BE versus SE valves, using the random-effects to calculate risk ratios and 95% confidence intervals (CIs).Ten cohort studies from April 2013 to November 2019 were included in this meta-analysis involving 13,478 subjects (6289 SE and 7189 BE types). Our study showed no statistical difference in IE rates between each type of valves (pooled OR 0.96, 95% CI: 0.68-1.35, p = 0.801 with I2 = 14.7%). There was no difference in IE rate between BE and SE valves following TAVR. Further studies are warranted to confirm our findings.

Background: New-onset atrial fibrillation (NOAF) is a frequent arrhythmic complication following transcatheter aortic valve replacement (TAVR). Choice of access routes for TAVR could be a factor that determines the risk of NOAF although the data is still not well-characterised. We aimed to assess the association between different access routes for TAVR (transfemoral versus non-transfemoral) and the risk of NOAF., Methods: A comprehensive literature review was performed through September 2018 using EMBASE and Medline. Eligible studies must compare the incidence of NOAF in patients without pre-existing atrial fibrillation who underwent TAVR. Relative risk (RR) and 95% confidence intervals (CI) were extracted from each study and combined together using the random-effects model, generic inverse variance method of DerSimonian and Laird., Results: Seven (7) retrospective studies with 18,425 patients who underwent TAVR (12,744 with the transfemoral approach and 5,681 with the non-transfemoral approach) met the eligibility criteria. After the procedures, 2,205 (12.0%) patients developed NOAF (656 [5.1%] patients in the transfemoral group and 1,549 [27.3%] patients in the non-transfemoral group). There was a significant association between the non-transfemoral approach and an increased risk of NOAF with the pooled RR of 2.94 (95%CI, 2.53-3.41; p < 0.00001). Subgroup analysis showed the highest risk of NOAF in the transapical subgroup with the pooled RR of 3.20 (95% CI, 2.69-3.80; I 2 33%)., Conclusions: A significantly increased risk of NOAF following TAVR among those who underwent a non-transfemoral approach compared with transfemoral approach was observed in this meta-analysis., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Introduction: Patients with previous coronary artery bypass graft (CABG) are usually considered as high-risk groups perioperatively. Recent studies suggest that previous CABG is not associated with mortality in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR). However, systematic review and meta-analysis of the literature has not been done. Thus, we conducted this systematic review and meta-analysis to assess the association between previous CABG and mortality in patients undergoing TAVR. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to July 2018. Included studies were published prospective or retrospective cohort studies that evaluated the effects of previous CABG status on mortality risk among patients undergoing TAVR. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Results: Eleven cohort studies from March 2010 to April 2018 were included in this meta-analysis involving 7299 subjects with severe AS undergoing TAVR (1890 with and 5409 without previous CABG). Previous CABG was not associated with all-cause mortality (pooled risk ratio = 0.96, 95% confidence interval: 0.80-1.16, p =.66, I 2 =21%) and cardiovascular (CV) mortality (pooled risk ratio = 1.23, 95% confidence interval: 0.64-2.39, p =.72, I 2 =35%). Conclusions: Previous CABG is not associated with either all-cause mortality or CV mortality in patients with severe AS undergoing TAVR. TAVR should be considered as an alternative or first-line treatment option among severe AS patient, regardless of previous CABG status.

Introduction: Significant tricuspid regurgitation is a well recognized indicator of right ventricular dysfunction. Recent studies have shown that significant tricuspid regurgitation is potentially associated with increased mortality in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). However, data remained sparse and inconclusive. Thus, we performed a systematic review and meta-analysis of the literature to assess the association between significant tricuspid regurgitation and mortality in post TAVR patients., Hypothesis: Significant tricuspid regurgitation is predictive for higher mortality in patients undergoing TAVR., Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published observational studies that reported multivariate analysis of the effects of significant tricuspid regurgitation on all-cause mortality among patients undergoing TAVR. Data from each study were combined utilizing the random-effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratios (ORs) and 95% confidence intervals (CIs)., Results: Nine cohort studies from August 2011 to May 2018 consisting of 27 614 patients with severe aortic stenosis undergoing TAVR (6255 with and 21 359 without significant tricuspid regurgitation) were included in this meta-analysis. The presence of significant tricuspid regurgitation was associated with higher all-cause mortality (pooled OR = 2.26, 95% CI: 1.45-3.52, P < 0.001). We found that all-cause mortality remained statistically substantial in all subgroups (30-day all-cause mortality: OR = 2.05, 95% CI: 1.20-3.49, P = 0.009; midterm all-cause mortality: OR = 9.67, 95% CI: 2.44-38.31, P = 0.001; and long-term all-cause mortality: OR = 1.48, 95% CI: 1.19-1.85, P < 0.001). Funnel plots and Egger's regression asymmetry test were performed and showed no publication bias., Conclusion: Significant tricuspid regurgitation increased risk of mortality by up to two-fold among patients with severe aortic stenosis undergoing TAVR. Our study suggests that significant tricuspid regurgitation should be considered a component of risk stratification tools.