Introduction As TAVI expands to younger and lower surgical risk severe AS patients, appropriately treating co-existent coronary artery disease is key to improving long-term cardiovascular outcomes. Recently, coronary physiology has been studied in patients undergoing TAVI in an attempt to incorporate it in revascularisation strategies. We seek to perform a meta-analysis of studies exploring the influence of TAVI on coronary physiology.
Methods We conducted a search of Medline and EMBASE to identify studies evaluating coronary physiology indices before and after TAVI. Double independent screenings and extractions were employed. Random effect meta-analysis with the inverse variance methods were used to estimate the pooled mean difference of coronary haemodynamic indices before and after TAVI. Analyses were performed with RevMan (Review Manager version 5.3.5, Nordic Cochrane Centre, Denmark).
Results Five studies evaluating coronary physiology in169 severe AS patients with 250 interrogated coronaries were included in the quantitative meta-analysis. The mean participant age and aortic valve area were 81 and 0.71cm2 respectively. In non-diseased coronary vessels, coronary flow reserve (CFR) and fractional flow reserve (FFR) did not significantly differ following TAVR; mean difference 0.11; 95% CI -0.10, 0.32; p=0.29; I2=0%; p=0.68; n=3 and mean difference -0.01; 95% CI -0.04, 0.03; p=0.75, I2=41; p=0.19; n=2 respectively. In stenosed vessels, FFR and instantaneous wave-free ratio (iFR) did not significantly change following TAVR with comparable precision; mean difference -0.01; 95% CI -0.03, 0.01; p=0.49, I2=0%; p=0.46; n=3 and mean difference 0.00; 95% CI -0.02, 0.02; p=1.00, I2=0; p=1.00; n=2 respectively.
Conclusion Our meta-analysis demonstrates that there are only minor, non-significant variations in coronary physiology measurements of severe AS patients before and after TAVI. The stability of invasive physiology assessment in severe AS patients is important for its incorporation in decision making algorithms. Studies investigating optimal ischaemic and intervention FFR and iFR cut-offs in patients with severe AS are anticipated.
Conflict of Interest None
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