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AIMS We performed a meta-analysis of currently available studies investigating the impact of postprocedural thrombocytopenia on mortality after transcatheter aortic valve implantation (TAVI). METHODS All studies researching the impact of postprocedural thrombocytopenia on mortality after TAVI were identified after searching PubMed and Web of Science through July 2019. The outcome of interest was early (in-hospital or 30-day) and overall (1- to 2-year) all-cause mortality after TAVI. From each study, the number of deaths in both patients with major (moderate/severe or higher postprocedural drop platelet counts defined in each study) and nonmajor (no/minor or lower drop platelet counts defined in each study) postprocedural thrombocytopenia was extracted. Then, odds ratios (ORs) of mortality for major vs. no/minor thrombocytopenia and their confidence intervals were generated. Alternatively, ORs and hazard ratios of mortality for major vs. no/minor thrombocytopenia (if available, adjusted) were directly extracted. Study-specific estimates were pooled in both the fixed-effect and random-effects models. RESULTS The principal pooled analysis demonstrated that postprocedural thrombocytopenia was associated with statistically significant increases in early (OR, 3.79; P for effect

OBJECTIVES To determine whether baseline C-reactive protein (CRP) levels can predict mortality after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies. METHODS All studies investigating the prognostic impact of baseline (preprocedural) CRP levels on all-cause mortality after TAVI were identified by means of searching PubMed and Google Scholar through May 2019. For each study, (preferentially, adjusted rather than unadjusted) odds/hazard ratios (ORs/HRs) with corresponding 95% confidence intervals of mortality per standard-deviation (SD) (or unit) increase in CRP levels or those for high vs low CRP levels. RESULTS Our search identified 14 eligible studies including a total of 3449 patients undergoing TAVI and reporting early (in-hospital to 3-month) and midterm (1-year to 3-year) all-cause mortality after TAVI. Pooled analyses demonstrated associations of high-baseline CRP levels with a marginal, but statistically nonsignificant increase in early mortality (pooled OR/HR per SD increase in CRP levels, 2.72; P = .09 and pooled OR/HR for high vs low CRP levels, 3.32; P = .07) and a statistically significant increase in midterm mortality after TAVI (pooled OR/HR per SD increase in CRP levels, 1.45; P

To identify prospective cohort studies enrolling adults and investigating an association of egg consumption with incidence and mortality of coronary artery disease (CAD), PubMed and Web of Science were searched through June 2019. Adjusted hazard ratios (HRs) of CAD incidence/mortality for more versus the least frequent egg consumption were extracted from each study. Study-specific estimates were pooled in the random-effects model. Sixteen eligible studies with a total of 1 285 505 participants were identified and included in the present meta-analysis. The primary meta-analysis pooling all HRs for the most versus least frequent egg consumption demonstrated that egg consumption was associated with significantly low CAD incidence/mortality (pooled HR: 0.93; 95% confidence interval: 0.89-0.98; I 2 = 9%). In the secondary meta-analyses (separately combining HRs for the third vs first tertile, the fourth vs first quartile, the third vs first quartile, the fifth vs first quintile, the fourth vs first quintile, and the third vs first quintile egg consumption), the fifth (vs first) quintile egg consumption was only associated with significantly low CAD incidence/mortality. In conclusion, egg consumption is independently associated with low incidence/mortality of CAD, which may be derived from the comparisons of the fifth versus first quintile egg consumption.

To determine whether television (TV) viewing is associated with cardiovascular disease (CVD) risk, we performed a meta-analysis of currently available prospective cohort studies. We systematically searched PubMed and Web of Science through April 2019. Eligible for inclusion in the present meta-analysis was a prospective cohort study investigating the association of TV viewing time with CVD risk (CVD prevalence, CVD incidence, cardiovascular events, and cardiovascular mortality). From each study, adjusted hazard ratios (HRs) of CVD risk were extracted. We separately combined study-specific estimates for dichotomous, tertile, quartile, and continuous values of TV viewing time in the random-effects model. The pooled analysis for dichotomous time demonstrated that CVD risk was significantly higher in the longer than shorter viewing (HR 1.28; p = 0.02). In the meta-analysis for tertile time, CVD risk was significantly higher in the longest than shortest tertile (T1) (HR 1.26; p = 0.0006), but there was no significant difference between the middle tertile and T1 (p = 0.51). The meta-analysis for quartile time indicated that CVD risk was significantly higher in the longest than shortest quartile (Q1) (HR 1.32; p = 0.0007), but there were no significant differences between the second longest quartile and Q1 (p = 0.12) and between the second shortest quartile and Q1 (p = 0.60). In the meta-analysis for continuous time, longer viewing was significantly associated with higher CVD risk (HR per 1-h/day increment; 1.06; p = 0.005). In conclusion, longer TV viewing time is significantly associated with higher CVD risk.

Outcomes after transsubclavian/transaxillary (TSc/TAx)-transcatheter aortic valve implantation (TAVI) have been unclear.To compare outcomes after TSc/TAx-TAVI versus transfemoral (TF)-TAVI, transapical (TAp)-TAVI, or transaortic (TAo)-TAVI, we performed meta-analysis of currently available studies.Studies considered for inclusion met the following criteria: the study population was patients undergoing TAVI; patients were assigned to TSc/TAx-TAVI and TF-TAVI, TAp-TAVI, or TAo-TAVI; and at least one of postprocedural early (30-day or in-hospital) or late (including early) outcomes was reported. An odds or hazard ratio of each early or late outcome with its 95% confidence interval for TSc/TAx-TAVI versus the other approach was extracted from each individual study and combined in the random-effects model.Our search identified 15 eligible reports from 12 studies including 10,528 patients. Pooled analysis of early all-cause mortality demonstrated a statistically significant reduction after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.003) or TAo-TAVI (P = 0.03). Pooled analysis of early pacemaker implantation demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TAp-TAVI (P = 0.0001) or TAo-TAVI (P0.00001). Pooled analysis of midterm all-cause mortality demonstrated a statistically significant increase after TSc/TAx-TAVI compared with TF-TAVI (P = 0.007).Early all-cause mortality was lower after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, early pacemaker implantation was more frequent after TSc/TAx-TAVI than TAp-TAVI or TAo-TAVI, and midterm all-cause mortality was higher after TSc/TAx-TAVI than TF-TAVI.

Introduction To determine whether renin-angiotensin system inhibitor (RASI) prescription is associated with better survival after transcatheter aortic valve implantation (TAVI), we performed the first meta-analysis of currently available studies. Evidence acquisition To identify all studies reporting impact of RASI prescription on survival after TAVI, we searched PubMed, Web of Science, and Google Scholar through October 2019 We extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence interval (CIs) of midterm (up to ≥6-month) allcause for RASI prescription from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random-effects model. Evidence synthesis We identified 13 eligible studies with a total of 26,132 TAVI patients and included them in the present meta-analysis. None was a randomized controlled trial, 5 were observational studies comparing patients with versus without RASI prescription (including 3 propensity score matched studies), and 8 were observational studies investigating RASI prescription as one of covariates. The primary meta-analysis of all studies demonstrated that RASI prescription was associated with significantly lower midterm mortality (HR, 0.83; 95% CI, 0.76 to 0.92; P = 0.0002). Although we identified significant funnel plot asymmetry (P = 0.036 by the rank correlation test) suggesting publication bias, correcting for it using the trim-and-fill method did not substantially alter the result favoring RASI prescription (corrected HR, 0.85; 95% CI, 0.76 to 0.95; P = 0.004). Conclusions RASI prescription may be associated with better midterm survival after TAVI.

AIMS To determine whether low-flow/low-gradient (LF/LG) aortic stenosis affects survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies. METHODS MEDLINE and EMBASE were searched through January 2019 using PubMed and OVID. Observational studies comparing all-cause mortality after TAVI for patients with classical LF/LG (C/LF/LG) aortic stenosis versus normal-flow/high-gradient (NF/HG) aortic stenosis, paradoxical LF/LG (P/LF/LG) aortic stenosis versus NF/HG aortic stenosis, and (3) C/LF/LG aortic stenosis versus P/LF/LG aortic stenosis were included. Study-specific estimates, risk and hazard ratios of mortality, were combined in the random-effects model. RESULTS Our search identified nine eligible studies including a total of 5512 TAVI patients. Pooled analysis demonstrated significantly higher early mortality in C/LF/LG aortic stenosis than NF/HG aortic stenosis (risk ratio, 1.72; P = 0.02) and no statistically significant difference in early mortality between P/LF/LG aortic stenosis and NF/HG aortic stenosis (P = 0.67) and between C/LF/LG aortic stenosis and P/LF/LG aortic stenosis (P = 0.51). Midterm mortality in C/LF/LG (risk ratio/hazard ratio, 1.73; P = 0.0003) and P/LF/LG aortic stenosis (risk ratio/hazard ratio, 1.48; P

OBJECTIVES To determine whether concomitant mitral stenosis (MS) impairs outcomes after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence. METHODS To identify all observational comparative studies of outcomes after TAVI for AS in patients with MS vs patients with no-MS, we searched databases (MEDLINE and EMBASE) using web-based search engines (PubMed and OVID). Studies meeting the following criteria were included; the design was an observational study; the study population was patients undergoing TAVI for AS; outcomes in patients with MS were compared with those in patients with no-MS. Study-specific estimates were then pooled using inverse variance-weighted averages of logarithmic odds and hazard ratios in the random-effects model. RESULTS We identified six eligible studies including 111 621 patients undergoing TAVI. In pooled analyses, postprocedural incidence of ≥ moderate paravalvular aortic regurgitation (PAR) (P = .02), early all-cause mortality (P = .008), early incidence of myocardial infarction (MI) (P = .01), and midterm all-cause mortality (P = .03) after TAVI were significantly higher in patients with MS than in patients with no-MS. There were no significant differences in early incidence of stroke, major bleeding, acute kidney injury, and new permanent pacemaker implantation after TAVI between patients with MS and patients with no-MS. When the study for mitral annular calcification was excluded in the pooled analyses, no results except for MI were substantially altered but the significance for early incidence of MI disappeared (P = .10). CONCLUSION Postprocedural incidence of ≥ moderate PAR, early all-cause mortality, early incidence of MI, and midterm all-cause mortality after TAVI are higher in patients with MS than in patients with no-MS.

To determine whether skipping breakfast is associated with heart disease, the first meta-analysis of currently available epidemiological studies was performed. To identify case-control, cross-sectional, longitudinal, or cohort studies investigating the association of skipping breakfast with prevalence, incidence, or mortality of heart disease in adults, PubMed, and Web of Science were searched through April 2019. Adjusted (if unavailable, unadjusted) hazard ratios (HRs) or odds ratios (ORs) with their confidence interval (CIs) of prevalence, incidence, or mortality for skipping breakfast were extracted from each study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs/ORs in the random-effects model. Eight eligible studies with a total of 284,484 participants were identified and included in the present meta-analysis. The primary meta-analysis combining HRs for Q1 (first quartile, most skipping breakfast) versus Q4 (fourth quartile, least skipping breakfast) from 3 studies together with other HRs/ORs demonstrated that skipping breakfast was associated with the significantly increased risk of heart disease (pooled HR/OR 1.24; 95% CI 1.09 to 1.40; p = 0.001). In sensitivity analyses combining HRs for Q2 (second quartile, second most skipping breakfast) versus Q4 or HRs for Q3 (third quartile, second least skipping breakfast) versus Q4 from 3 studies together with other HRs/ORs, the association of skipping breakfast with the increased risk of heart disease in the primary meta-analysis was confirmed. In conclusion, skipping breakfast is associated with the increased risk of heart disease.

To determine whether statin (hydroxymethylglutaryl-CoA reductase inhibitor) therapy is associated with better midterm survival after transcatheter aortic valve implantation (TAVI), the first meta-analysis of currently available studies was performed. To identify all observational comparative studies and randomized controlled trials (RCTs) of statin versus control (no statin) therapy or cohort studies investigating statin treatment as one of covariates in patients undergoing TAVI, PubMed, Web of Science, and Google Scholar were searched through March 2019. Adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence interval (CIs) of midterm (≥1 year) all-cause mortality after TAVI for statin therapy were extracted from each study. Study-specific estimates were combined by means of inverse variance-weighted averages of logarithmic HRs in the random-effects model. Eight eligible studies with a total of 5,170 TAVI patients were identified and included in the present meta-analysis. The primary meta-analysis (including HRs for high intensity statin from 3 studies together with other HRs) demonstrated that statin treatment was associated with significantly lower midterm mortality (HR, 0.74; 95% CI, 0.60 to 0.91; p = 0.005). The secondary meta-analysis (including HRs for low/moderate intensity statin from 3 studies together with other HRs) also indicated an association of statin therapy with significantly lower midterm mortality (HR, 0.80; 95% CI, 0.69 to 0.93; p = 0.005). No funnel plot asymmetry for the primary meta-analysis (p = 0.64) was identified, which suggested probably no publication bias. In conclusion, statin therapy is associated with better midterm survival after TAVI.

To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).

To evaluate whether liver disease is associated with increased mortality after transcatheter aortic valve implantation (TAVI) and whether TAVI is associated with decreased mortality compared to surgical aortic valve replacement (SAVR) in patients with liver disease, we performed meta-analyses of currently available studies.Studies reporting mortality in TAVI patients with liver disease versus those without liver disease and mortality after TAVI versus SAVR in patients with liver disease were eligible to be included. A relative risk (RR) or hazard ratio of mortality for TAVI patients with versus without liver disease and mortality for TAVI versus SAVR in patients with liver disease was extracted from each individual study. Study-specific estimates were combined in the random-effects model.We identified nine studies of TAVI patients with versus without liver disease and four studies of TAVI versus SAVR in patients with liver cirrhosis. Pooled analyses demonstrated no association of liver disease with early (in-hospital/30-day) mortality (P = 0.28), but a statistically significant association of liver disease with increases mid-term (1-2-year) mortality (hazard ratio 1.87, P 0.00001) in TAVI patients, and no statistically significant difference in in-hospital mortality between TAVI and SAVR in patients with cirrhosis (RR 0.60, P = 0.12).There may be no impact of liver disease on early mortality in TAVI patients, negative impact of liver disease on mid-term mortality in TAVI patients, and no difference in in-hospital mortality between TAVI and SAVR in patients with liver cirrhosis.

We performed a meta-analysis of currently available studies investigating impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using PubMed and OVID. Studies considered for inclusion met the following criteria: the design was a study researching impact of baseline NT-proBNP levels on survival; the study population was patients underwent TAVI for AS; outcomes included all-cause mortality. For each study, we directly extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high vs low baseline NT-proBNP); and generated ORs using mortality rates in both patients with high and low levels of baseline NT-proBNP. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. We identified 16 eligible studies including a total of 3,679 patients who underwent TAVI for AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP were associated with a statistically nonsignificant increase in early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence interval, 1.54 to 2.28; p0.00001). Although funnel-plot asymmetry suggesting publication bias was detected, adjusting for funnel-plot asymmetry indicated an association of high levels of baseline NT-proBNP with a still significant increase in midterm mortality. In conclusion, high levels of baseline NT-proBNP predict increased midterm, not early, mortality after TAVI for AS.

Although a number of studies compared mortality after transcatheter aortic valve implantation (TAVI) with that after surgical aortic replacement (SAVR) in patients with chronic obstructive pulmonary disease (COPD), no meta-analysis of them has been conducted to date. To determine whether TAVI or SAVR is associated with better postprocedural survival in patients with COPD, a meta-analysis of all studies currently available was performed.

Although it has been reported that coexistent chronic diseases are strongly associated with COVID-19 severity, investigations of predictors for SARS-CoV-2 infection itself have been seldom performed. To screen potential risk and protective factors for SARS-CoV-2 infection, meta-regression of data from worldwide nations were herein conducted. We extracted total confirmed COVID-19 cases in worldwide 180 nations (May 31, 2020), nation total population, population ages 0-14/≥65, GDP/GNI per capita, PPP, life expectancy at birth, medical-doctor and nursing/midwifery-personnel density, hypertension/obesity/diabetes prevalence, annual PM2.5 concentrations, daily ultraviolet radiation, population using safely-managed drinking-water/sanitation services and hand-washing facility with soap/water, inbound tourism, and bachelor’s or equivalent (ISCED 6). Restricted maximum-likelihood meta-regression in the random-effects model was performed using Comprehensive Meta-Analysis version 3. To adjust for other covariates, we conducted the hierarchical multivariate models. A slope (coefficient) of the meta-regression line for the COVID-19 prevalence was significantly negative for population ages 0-14 (–0.0636; P = .0021) and positive for obesity prevalence (0.0411; P = .0099) and annual PM2.5 concentrations in urban areas (0.0158; P = .0454), which would indicate that the COVID-19 prevalence decreases significantly as children increase and that the COVID-19 prevalence increases significantly as the obese and PM2.5 increase. In conclusion, children (negatively) and obesity/PM2.5 (positively) may be independently associated with SARS-CoV-2 infection.

A recent study from China suggests that high temperature and ultraviolet (UV) radiation cannot decrease the epidemics of Coronavirus disease 2019 (COVID-19). To determine whether COVID-19 prevalence is modulated by meteorological conditions, meta-regression of Japanese prefectural data was herein conducted. We extracted integrated number of patients testing positive for COVID-19 in each Japanese prefecture on 18 May 2020, population per 1-km2 inhabitable area in the prefecture in 2020, and monthly meteorological conditions at each prefectural capital city for 4 months (from January to April 2020). We averaged or cumulated the monthly data for the 4 months. To adjust for prefectural population density, we defined the COVID-19 prevalence as the integrated number of patients testing positive divided by the population per 100-km2 inhabitable area. Random-effects meta-regression was performed. A slope of the meta-regression line was significantly negative for mean air temperature (coefficient, −0.134; P = 0.019), mean sea level air pressure (−0.351; P = 0.001), and mean daily maximum UV index (−0.908; P = 0.012), which indicated that COVID-19 prevalence decreased significantly as air temperature, air pressure, and UV index increased. In conclusion, higher temperature, pressure, and UV may be associated with less COVID-19 prevalence, which should be confirmed by further epidemiological investigations taking other risk and protective factors of COVID-19 into account.

BackgroundTo determine whether transcatheter aortic valve implantation (TAVI) improves early (30-day) and midterm (1-year) mortality compared with surgical aortic valve replacement (SAVR), we performed an updated meta-analysis of all the currently available randomised controlled trials (RCTs).MethodsTo identify all RCTs providing both 30-day and 1‑year mortality after TAVI versus SAVR, PubMed and ClinicalTrials.gov were searched up to and including July 2019. A risk difference (RD) and its 95% confidence interval were generated using data of prespecified outcomes in both the TAVI and SAVR groups. Study-specific estimates were pooled using inverse variance-weighted averages of RDs in the random-effects model.ResultsWe identified seven eligible high-quality RCTs including a total of 7631 as-treated patients. Pooled analyses demonstrated significantly lower 30-day (RD −0.60%;p = 0.046) and 1‑year all-cause mortality (RD −1.12%;p = 0.03) after TAVI than after SAVR. No funnel plot asymmetry was detected for 30-day and 1‑year mortality. Meta-regression analyses indicated that RDs of 30-day and 1‑year mortality between TAVI and SAVR were not modulated by mean Society of Thoracic Surgeons Predicted Risk of Mortality score. Bleeding complications at 30 days and 1 year and stage 2/3 acute kidney injury at 30 days were significantly less frequent after TAVI than after SAVR, whereas major vascular complications and new permanent pacemaker implantation at 30 days and 1 year were significantly more frequent after TAVI than after SAVR.ConclusionThe best evidence from the present meta-analysis of all the currently available RCTs suggests that TAVI may reduce 30-day and 1‑year all-cause mortality compared with SAVR.

INTRODUCTION The aim of this study was to determine whether peripheral arterial disease (PAD) is an independent predictor of mortality in patients who undergo transcatheter aortic valve implantation (TAVI) and we performed meta-analysis of currently available studies. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched through June 2018 using Web-based search engines (PubMed and OVID). We included comparative studies of patients with PAD versus those without PAD and cohort studies which investigated PAD as one of prognostic factors of mortality, which used the multivariable analysis and reported an adjusted odds and hazard ratio (OR/HR) for early (30-day or in-hospital) and late (including early) mortality after TAVI. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS The primary meta-analysis which pooled all the ORs/HRs demonstrated that PAD was associated with a statistically significant increase in both early (OR, 1.21; P=0.02) and midterm (1-year to 7-year) mortality (HR, 1.31; P

Objectives We performed a meta-analysis of transcatheter mitral valve implantation (TMVI) for deteriorated bioprosthetic valves (valve-in-valve [VIV]-TMVI) and/or failed annuloplasty rings (valve-in-ring [VIR]-TMVI), comparing observed early (30-day) mortality with predicted operative mortality. Background It remains unclear whether VIV/VIR-TMVI reduces mortality as compared with redo MVS. Methods MEDLINE and EMBASE were searched current through 24 July 2018 using Web-based search engines (PubMed and OVID) to identify studies including ≥10 patients undergoing VIV/VIR-TMVI. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM]) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using the inverse variance-weighted average of logarithmic RRs in the random-effects model. One-group meta-analyses of 30-day/late (including 30-day) mortality rates were also performed in the random-effects model. Results Of 270 potentially relevant articles screened initially, 17 eligible studies including a total of 1017 patients undergoing VIV/VIR-TMVI were identified. In all but four studies, the STS-PROM was available and varied from 7.7% to 22.0% (weighted mean, 11.5%). Pooled analyses of all VIV/VIR-TMVI studies demonstrated the 30-day mortality rate of 5.4% (95%CI, 4.0-6.8%), the midterm (1- to 5-year) mortality rate of 13.7% (95%CI, 9.0-18.5%), and significantly lower observed 30-day mortality than predicted operative mortality (RR, 0.67; 95%CI, 0.49-0.91; P = 0.01). Conclusions VIV/VIR-TMVI brought about relatively low early and midterm (1- to 5-year) mortality, and observed 30-day mortality was significantly lower than predicted operative mortality.

We performed a meta-analysis of currently available studies assessing prognostic value of psoas-muscle area (PMA) on mortality in patients who underwent transcatheter aortic valve implantation (TAVI). MEDLINE and EMBASE were searched through May 2018 to identify studies reporting ≥1-year all-cause mortality in PMA-stratified TAVI patients. A hazard ratio of follow-up (including early) mortality for "lowest-quantile" versus "higher-quantiles" PMA. Study-specific estimates were combined in the random-effects model. Our search identified 6 eligible studies enrolling a total of 1,237 TAVI patients with 1-year to 2-year (midterm) follow-up. A primary meta-analysis pooling all hazard ratios for "lowest-quantile versus higher-quantiles" PMA demonstrated significantly higher mortality in "lowest-quantile" than "higher-quantiles" patients (p0.0001). A subgroup meta-analysis indicated no significant difference in mortality between "50th- and ≥50th-percentile" patients (p = 0.95), but significantly higher mortality in "lowest-tertile" than "higher-tertiles" patients (p = 0.0009) and in "lowest-quartile" than "higher- quartiles" patients (p = 0.0003). A secondary meta-analysis revealed significantly higher mortality in "lowest-tertile" than "mid-tertile" patients (p = 0.01) and in "lowest-tertile" than "highest-tertile" patients (p = 0.01). A gender-stratified meta-analysis showed significantly higher mortality in "lowest-quantile" than "higher-quantiles" patients in both men (p = 0.0008) and women (p = 0.01). In conclusion, low PMA, especially "lowest-tertile/quartile" PMA, is a predictor of high all-cause mortality at midterm follow-up after TAVI for both men and women. However, PMA categorization into 50th percentiles may be invalid to predict mortality.

OBJECTIVES To determine whether preprocedural left ventricular (LV) diastolic dysfunction impairs midterm mortality after transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence. METHODS We identified all studies investigating impact of preprocedural severity of LV diastolic dysfunction on midterm (≥1-year) all-cause mortality after TAVI for patients with AS through a search of databases (MEDLINE and EMBASE) until September 2019. From each study, we extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of midterm mortality. We pooled study-specific estimates in the random-effects model. RESULTS Ten eligible studies with a total of 2380 patients with AS undergoing TAVI were identified. In accordance with pooled analyses, higher-grade preprocedural LV diastolic dysfunction was associated with significantly worse midterm all-cause mortality after TAVI compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P

AIMS We performed meta-analyses of echocardiographic outcomes, including postprocedural aortic valve area (AVA), aortic valve mean pressure gradient (MPG), and paravalvular aortic regurgitation (PAR), exclusively from all currently available randomized controlled trials (RCTs) of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR). METHODS To identify all RCTs providing echocardiographic outcomes (AVA, MPG, and PAR) up to 2 years after TAVI versus SAVR, PubMed and ClinicalTrials.gov were searched through June 2019. Mean differences in AVA (and MPG) between the TAVI and SAVR groups and odds (or hazard) ratios of at least moderate PAR for TAVI versus SAVR were pooled using the random-effects meta-analysis. RESULTS We identified seven eligible RCTs. At 30 days (P = 0.004), 1 year (P = 0.006), and 2 years (P = 0.03), AVA was significantly larger after TAVI than after SAVR. After TAVI than after SAVR, MPG was significantly lower at 30 days (P = 0.03) and 2 years (P = 0.01), and nonsignificantly lower at 1 year (P = 0.06). At 30 days (P

INTRODUCTION To determine whether troponin (Tn) can predict mortality after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of currently available studies investigating impact of baseline and postprocedural Tn. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched through April 2019 using PubMed and OVID. Studies considered for inclusion met the following criteria: the study investigating impact of baseline and postprocedural Tn on mortality; the study population was patients undergoing TAVI for aortic stenosis (AS); outcomes included early (30-day or in-hospital)/late (including early) mortality. For each study, data regarding early/late mortality in both high and low (defined in each study) level of baseline/postprocedural Tn groups were used to generate odds ratios (ORs) and 95% confidence intervals (CIs), or reported ORs and hazard ratios (HRs) with 95% CIs were directly extracted. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. EVIDENCE SYNTHESIS We identified 19 eligible studies including a total of 7555 patients undergoing TAVI. Pooled analyses demonstrated associations of high levels of baseline Tn with statistically significant increases in both 30-day (P=0.002) and midterm mortality (P

To determine whether baseline gait speed predicts mortality after transcatheter aortic valve implantation (TAVI), a meta-analysis of currently available studies was performed.To identify all studies researching the impact of preprocedural gait speed on mortality after TAVI, PubMed and Web of Science were searched through May 2019. Adjusted (if unavailable, unadjusted) hazard/odds ratios (ORs/HRs) with their confidence interval of mortality for slow (if available, the slowest) versus fast (if available, the fastest) gait speed (with cut-off values defined in each study) and those for unable to walk versus walker (if available, with the fastest gait speed) were extracted from each study, and then separately pooled by means of inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model.Twelve eligible studies (7 and 5 based on the distance-limited and time-limited walk test, respectively) were identified and integrated in the present meta-analysis. The pooled analysis of all ORs/HRs demonstrated that slow walkers (primary meta-analysis; OR/HR, 2.38; p 0.00001) and unable to walk (OR/HR, 1.75; p = 0.01) were significantly associated with increased mortality. The subgroup analysis for the primary meta-analysis indicated no significant subgroup difference between studies utilizing the 4-m/5-m/15-foot walk test and those applying the 6-min walk test (p = 0.45). Combining studies with 1-year follow-up did not alter the primary result (p 0.0001). Pooling studies with adjusted ORs/HRs did not change the principal result (p = 0.0002). No funnel plot asymmetry for the primary meta-analysis was identified.Slow baseline gait speed (and unable to walk) is associated with increased mortality after TAVI.

Objectives We performed a meta-analysis to determine the outcomes in patients undergoing transcatheter mitral valve replacement (TMVR) for mitral regurgitation (MR). Methods Databases including MEDLINE and EMBASE were searched through April 2018 using Web-based search engines (PubMed and OVID) to identify single-arm observational (case series) studies of TMVR enrolling ≥5 patients with MR. For each study, data regarding observed 30-day mortality and predicted operative mortality (Society of Thoracic Surgeons Predicted Risk of Mortality) were used to generate risk ratios (RRs) and 95% confidence intervals (CIs). Study-specific estimates were combined using the inverse variance-weighted average of logarithmic RRs in the random-effects model. One-group meta-analyses of 30-day and >30-day (including 30-day) mortality were also performed in the random-effects model. Results Of 222 potentially relevant articles screened initially, nine eligible studies enrolling a total of 146 patients with MR undergoing TMVR were identified. In all but two studies, STS-PROM was available and varied from 3.3% to 15.4% (arithmetic mean, 7.6%). Pooled analyses demonstrated 30-day mortality of 20.4% (95%CI, 9.6-31.2%), >30-day mortality of 32.0% (95%CI, 19.8-44.2%), and non-significantly higher observed 30-day mortality than predicted operative mortality (RR, 1.70; 95%CI, 0.85-3.42; P = 0.14). There was no evidence of significant publication bias. Conclusion TMVR for patients with MR results in increased early and late mortality.

Objectives We sought to determine whether off-pump coronary artery bypass grafting (CABG) increases long-term mortality, by performing a meta-analysis of randomized controlled trials (RCTs) of off-pump versus on-pump CABG with ≥5-year follow-up. Methods MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long-term (≥5-year) mortality for off-pump versus on-pump CABG were extracted from each individual trial. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs in the random-effects model. Results Our search identified eight medium- to large-size RCTs at low risk of bias with long-term follow-up of off-pump versus on-pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off-pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta-analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on-pump CABG (HR, 1.19; P = 0.05). Conclusions Off-pump CABG increases long-term (≥5-year) mortality compared with on-pump CABG.

To assess outcomes of transcatheter aortic valve implantation (TAVI) for pure native aortic regurgitation (AR) and to evaluate whether 30-day all-cause mortality is modulated by patient characteristics, we performed a meta-analysis and meta-regression of currently available studies.Studies enrolling ≥20 patients undergoing TAVI for AR were considered for inclusion. Study-specific estimates (incidence rates of outcomes) were combined using one-group meta-analysis in a random-effects model. Subgroup meta-analysis of studies exclusively using early-generation devices (EGD) and new-generation devices (NGD) and stepwise random-effects multivariate meta-regression were also performed.The search identified 11 eligible studies including a total of 911 patients undergoing TAVI for AR. Pooled analysis demonstrated an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p 0.001), moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD 3.4%, EGD 17.3%; p 0.001), 30-day all-cause mortality of 9.5% (NGD 6.1%, EGD 14.7%; p 0.001), mid-term (4 mo - 1 yr) all-cause mortality of 18.8% (NGD 11.8%, EGD 32.2%; p 0.001), life-threatening/major bleeding complications (BC) 5.7% (NGD 3.5%, EGD 12.4%; p = 0.015), and major vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%; p = 0.041). All coefficients in the multivariate meta-regression adjusting simultaneously for the proportion of diabetes mellitus, chronic obstructive pulmonary disease, peripheral arterial disease, concomitant moderate or higher mitral regurgitation, and mean left ventricular ejection fraction (with significant coefficients in the univariate meta-regression) were not statistically significant.Thirty (30)-day all-cause mortality after TAVI for AR was high (9.5%) with a high incidence of moderate or higher PAR (7.4%). Compared with EGD, NGD was associated with significantly higher device success rates and significantly lower rates of second-valve deployment, moderate or higher PAR, 30-day/mid-term all-cause mortality, serious BC, and MVC.

To establish evidence whether baseline anemia and decreases in baseline hemoglobin levels affect survival after transcatheter aortic valve implantation (TAVI), we performed a meta-analysis of available studies. Studies considered for inclusion met the following criteria: the design was a comparative study of patients with baseline anemia versus those without baseline anemia or a cohort study investigating baseline anemia (as a dichotomous variable) or baseline hemoglobin levels (as a continuous variable) as one of prognostic factors of mortality; the study population was patients who underwent TAVI; and main outcomes included early (30-day or in-hospital) or late (including early) all-cause mortality. Study-specific estimates were combined in the random-effects model. Our search identified 15 eligible studies including a total of 11,657 TAVI patients. Pooled analysis demonstrated that baseline anemia was associated with a statistically significant increase in early (p = 0.003) and midterm mortality (p0.0001) and that incremental decreases in baseline hemoglobin levels were associated with a statistically significant increase in midterm mortality (p0.00001). Pooled analysis of only adjusted estimates indicated that anemia was independently associated with a statistically significant increase in early (p = 0.02) and midterm mortality (p0.0001) and that incremental decreases in baseline hemoglobin levels were independently associated with a statistically significant increase in midterm mortality (p0.00001). In conclusion, baseline anemia and lower baseline hemoglobin levels may be associated with increased early and midterm mortality after TAVI.

To determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic-valve implantation (TAVI), we performed a meta-analysis of currently available studies.MEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in-hospital or 30-day) and late (including early) all-cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non-significant (typically, ≥moderate versusmoderate) TR was extracted. Study-specific estimates were combined in the random-effects model.Our search identified 12 eligible studies enrolling a total of 41,485 TAVI patients. The meta-analysis for early mortality combining 3 ORs demonstrated a significant 1.80-fold increase in mortality with significant TR (OR, 1.80; 95% CI, 1.01 to 3.19; P = 0.05). The primary meta-analysis for midterm (6-month to 30-month) mortality combining all the 12 HRs/ORs indicated a significant 1.96-fold increase in mortality (HR/OR, 1.96; 95% CI, 1.35 to 2.85; P = 0.0004). The secondary meta-analysis for midterm mortality combining 7 homogeneous HRs (adjusted HRs for ≥moderate versusmoderate TR) showed a significant 2.25-fold increase in mortality (HR, 2.25; 95% CI, 1.20-4.24; P = 0.01).Concurrent significant (typically, ≥moderate) TR is associated with an approximately two-fold increase in both early and midterm all-cause mortality in patients with AS undergoing TAVI.

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annulus calcification. Herein, we present computed tomographic images of formation of CCMA over time.

Background In tetralogy of Fallot (TOF), it is well known that postoperative pulmonary regurgitation reduces right ventricular function during long-term follow-up. Complete repair without a transannular patch should help avoid pulmonary regurgitation. Recently, primary complete repair has been preferred to the staged repair with use of a Blalock-Taussig shunt (BTS) even in neonates or small infants; however, little has been reported about the influence of a BTS on pulmonary annular growth. Methods We examined 40 patients with TOF or double-outlet right ventricle with pulmonary stenosis. Twenty-one patients received a BTS before complete repair, whereas 19 patients underwent primary complete repair. Pulmonary annular size was measured by echocardiography before BTS, complete repair, or both, and ventricular volume was measured by cardiac catheterization. Results There were no significant differences in complete repair age or body size between the groups. Pulmonary annulus sizes in the BTS group were smaller than those in the primary repair group (Z score, −5.1 ± 2.5 vs −3.7 ± 1.8). After the BTS, significant annular growth (Z score, −2.8 ± 2.1) was observed ( p = 0.0028), with a significant increase in left ventricular end-diastolic volume ( p = 0.015). When patients with severe pulmonary stenosis (Z score > −7.0) were excluded, pulmonary annular preservation at complete repair was achieved in 64.7% (11/17) of the BTS group and 36.8% (7/19) of the primary repair group ( p = 0.088). Conclusions The BTS increased the pulmonary annular size and the left ventricular volume during the 6 months before complete repair, resulting in preservation of the pulmonary valve function.

A 41-year-old male patient was diagnosed acute myocardial infarction. An intra-aortic balloon pump was inserted to treat heart failure, and off-pump coronary artery bypass surgery was performed. Postoperative cardiac catheterization revealed occlusion of all the 3 bypass grafts, and percutaneous coronary intervention (PCI) was performed. Thrombosis due to heparin-induced thrombocytopenia (HIT) occurred during PCI, which was completed after switching to argatroban based on the possible HIT. Cardiopulmonary arrest occurred suddenly after PCI, and the patient died. Undetected HIT may have caused the sudden change. HIT should be suspected and aggressively treated when thrombocytopenia occurs even during assisted circulation.