Clinical efficacy of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LEI Xiang ¹ , LIU Shidong ¹ , FANG Tao ¹ , HAN Xiangxiang ¹ , WANG Jialu ¹ ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P.R.China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

SONG Bing, Email: songbing@163.com

Keywords：

Transcatheter aortic valve replacement; old age; efficacy; safety; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202002029

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the complications of transcatheter aortic valve replacement (TAVR) between aortic valve stenosis (AS) patients ≥90 years and patients <90 years, and to explore the efficacy and safety of TAVR in AS patients ≥90 years.Methods Databases including PubMed, The Cochrane Library, EMbase, Medline, CNKI, Wanfang Data and China Biology Medicine disc (CBMdisc) were searched by computer from inception to May 2019. Two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. RevMan 5.3 and Stata 15.0 were used for meta-analysis.Results A total of 12 cohort studies were included, including60 186 patients (11 350 patients ≥90 years and 48 836 patients <90 years). Meta-analysis showed that compared with the patients <90 years, those ≥90 years had higher all-cause mortality in the hospital (OR=1.51, 95%CI 1.37 to 1.66, P<0.000 01),on postoperative 30 d (OR=1.68, 95%CI 1.50 to 1.89, P<0.000 01) and at postoperative 1 year (OR=1.36, 95%CI 1.25 to 1.48, P<0.000 01), and had higher incidence of stroke (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01), bleeding events (OR=1.14, 95%CI 1.07 to 1.20, P<0.000 01) and vascular complications (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01). Conclusion All-cause mortality and the incidence of some complications after TAVR in AS patients ≥90 years are higher than those in patients <90 years, but this difference is clinically acceptable. Therefore, TAVR treatment is safe and effective for elderly patients.

Citation： LEI Xiang, LIU Shidong, FANG Tao, HAN Xiangxiang, WANG Jialu, SONG Bing. Clinical efficacy of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1446-1453. doi: 10.7507/1007-4848.202002029 Copy

1.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
2.	Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
3.	Bouma BJ, van Den Brink RB, van Der Meulen JH, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart, 1999, 82(2): 143-148.
4.	Charlson E, Legedza AT, Hamel MB. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis, 2006, 15(3): 312-321.
5.	吴永健. 经导管主动脉瓣置换术的现状、研究热点和未来展望. 中国循环杂志, 2017, 32(2): 120-122.
6.	Rosenhek R, Iung B, Tornos P, et al. ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J, 2012, 33(7): 822-828.
7.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
8.	Sponga S, Isola M, Bagur R, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old. Interact Cardiovasc Thorac Surg, 2017, 25(4): 526-532.
9.	Olasinska-Wisniewska A, Grygier M, Lesiak M, et al. Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age. Cardiol J, 2017, 24(4): 358-363.
10.	Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
11.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
12.	Abramowitz Y, Chakravarty T, Jilaihawi H, et al. Comparison of outcomes of transcatheter aortic valve implantation in patients ≥90 years versus <90 years. Am J Cardiol, 2015, 116(7): 1110-1115.
13.	Arsalan M, Szerlip M, Vemulapalli S, et al. Should transcatheter aortic valve replacement be performed in nonagenarians?: Insights from the STS/ACC TVT Registry. J Am Coll Cardiol, 2016, 67(12): 1387-1395.
14.	Doshi R, Patel V, Shah P. Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement: a propensity matched analysis. J Geriatr Cardiol, 2018, 15(2): 123-130.
15.	Escárcega RO, Baker NC, Lipinski MJ, et al. Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement. Am Heart J, 2016, 173: 118-125.
16.	Ichimoto E, Arnofsky A, Wilderman M, et al. Early mortality and safety after transcatheter aortic valve replacement using the SAPIEN 3 in nonagenarians. J Geriatr Cardiol, 2018, 15(6): 387-393.
17.	Miura M, Shirai S, Uemura Y, et al. Early safety and efficacy of transcatheter aortic valve implantation for Asian nonagenarians (from KMH Registry). Int Heart J, 2017, 58(6): 900-907.
18.	Scholtz S, Dimitriadis Z, Vlachojannis M, et al. Transcatheter aortic valve implantation in nonagenarians: procedural outcome and mid-term results. Heart Lung Circ, 2018, 27(6): 725-730.
19.	Vendrik J, van Mourik MS, van Kesteren F, et al. Comparison of outcomes of transfemoral aortic valve implantation in patients <90 with those >90 years of age. Am J Cardiol, 2018, 121(12): 1581-1586.
20.	Vlastra W, Chandrasekhar J, Vendrik J, et al. Transfemoral TAVR in nonagenarians: from the CENTER collaboration. JACC Cardiovasc Interv, 2019, 12(10): 911-920.
21.	Yamamoto M, Meguro K, Mouillet G, et al. Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged ≥90 years versus <90 years. Am J Cardiol, 2012, 110(8): 1156-1163.
22.	Yamamoto M, Mouillet G, Meguro K, et al. Clinical results of transcatheter aortic valve implantation in octogenarians and nonagenarians: insights from the FRANCE-2 registry. Ann Thorac Surg, 2014, 97(1): 29-36.
23.	Yokoyama H, Tobaru T, Muto Y, et al. Long-term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi-center analysis. Clin Cardiol, 2019, 42(6): 605-611.
24.	Writing group members, Lloyd-Jones D, Adams RJ, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation, 2010, 121(7): e46-e215.
25.	Levy Praschker BG, Leprince P, Bonnet N, et al. Cardiac surgery in nonagenarians: hospital mortality and long-term follow-up. Interact Cardiovasc Thorac Surg, 2006, 5(6): 696-699.
26.	Idoate F, Cadore EL, Casas-Herrero A, et al. Noncoronary vascular calcification, bone mineral density, and muscle mass in institutionalized frail nonagenarians. Rejuvenation Res, 2017, 20(4): 298-308.
27.	Mangieri A, Montalto C, Poletti E, et al. Thrombotic versus bleeding risk after transcatheter aortic valve replacement: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(16): 2088-2101.
28.	Raheja H, Garg A, Goel S, et al. Comparison of single versus dual antiplatelet therapy after TAVR: A systematic review and meta-analysis. Catheter Cardiovasc Interv, 2018, 92(4): 783-791.
29.	Piazza N, Onuma Y, Jesserun E, et al. Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. JACC Cardiovasc Interv, 2008, 1(3): 310-316.
30.	Baan J Jr, Yong ZY, Koch KT, et al. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis. Am Heart J, 2010, 159(3): 497-503.
31.	Bleiziffer S, Ruge H, Hörer J, et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2010, 3(5): 524-530.
32.	Calvi V, Puzzangara E, Pruiti GP, et al. Early conduction disorders following percutaneous aortic valve replacement. Pacing Clin Electrophysiol, 2009, 32 (Suppl 1): S126-S130.
33.	Erkapic D, Kim WK, Weber M, et al. Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. Europace, 2010, 12(8): 1188-1190.
34.	Jilaihawi H, Chin D, Vasa-Nicotera M, et al. Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J, 2009, 157(5): 860-866.
35.	Latsios G, Gerckens U, Buellesfeld L, et al. "Device landing zone" calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI. Catheter Cardiovasc Interv, 2010, 76(3): 431-439.
36.	Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation, 2011, 123(9): 951-960.
37.	Saia F, Lemos PA, Bordoni B, et al. Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis: prediction of the need for permanent pacemaker using simple baseline and procedural characteristics. Catheter Cardiovasc Interv, 2012, 79(5): 712-719.
38.	Ozcan KS, Osmonov D, Altay S, et al. Pacemaker implantation complication rates in elderly and young patients. Clin Interv Aging, 2013, 8: 1051-1054.
39.	Mandawat A, Curtis JP, Mandawat A, et al. Safety of pacemaker implantation in nonagenarians: an analysis of the healthcare cost and utilization project-nationwide inpatient sample. Circulation, 2013, 127(14): 1453-1465.
40.	Auffret V, Bedossa M, Boulmier D, et al. From FRANCE 2 to FRANCE TAVI: are indications, technique and results of transcatheter aortic valve replacement the same? Presse Med, 2015, 44(7-8): 752-760.
41.	Zack CJ, Al-Qahtani F, Kawsara A, et al. Comparative outcomes of surgical and transcatheter aortic valve replacement for aortic stenosis in nonagenarians. Am J Cardiol, 2017, 119(6): 893-899.
42.	Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J, 1980, 99(4): 419-424.
43.	George I, Yerebakan H, Kalesan B, et al. Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians. J Thorac Cardiovasc Surg, 2014, 148(4): 1360-1369.
44.	Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
45.	Okoh AK, Chauhan D, Kang N, et al. The impact of frailty status on clinical and functional outcomes after transcatheter aortic valve replacement in nonagenarians with severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(6): 1000-1006.
46.	Biancari F, D'Errigo P, Rosato S, et al. Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessels, 2017, 32(2): 157-165.
47.	McNeely C, Zajarias A, Robbs R, et al. Transcatheter aortic valve replacement outcomes in nonagenarians stratified by transfemoral and transapical approach. Ann Thorac Surg, 2017, 103(6): 1808-1814.
48.	Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

1. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg, 2012, 42(4): S1-S44.
2. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
3. Bouma BJ, van Den Brink RB, van Der Meulen JH, et al. To operate or not on elderly patients with aortic stenosis: the decision and its consequences. Heart, 1999, 82(2): 143-148.
4. Charlson E, Legedza AT, Hamel MB. Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis, 2006, 15(3): 312-321.
5. 吴永健. 经导管主动脉瓣置换术的现状、研究热点和未来展望. 中国循环杂志, 2017, 32(2): 120-122.
6. Rosenhek R, Iung B, Tornos P, et al. ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J, 2012, 33(7): 822-828.
7. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
8. Sponga S, Isola M, Bagur R, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients over 85 years old. Interact Cardiovasc Thorac Surg, 2017, 25(4): 526-532.
9. Olasinska-Wisniewska A, Grygier M, Lesiak M, et al. Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age. Cardiol J, 2017, 24(4): 358-363.
10. Corbett MS, Higgins JP, Woolacott NF. Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods, 2014, 5(1): 79-85.
11. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
12. Abramowitz Y, Chakravarty T, Jilaihawi H, et al. Comparison of outcomes of transcatheter aortic valve implantation in patients ≥90 years versus <90 years. Am J Cardiol, 2015, 116(7): 1110-1115.
13. Arsalan M, Szerlip M, Vemulapalli S, et al. Should transcatheter aortic valve replacement be performed in nonagenarians?: Insights from the STS/ACC TVT Registry. J Am Coll Cardiol, 2016, 67(12): 1387-1395.
14. Doshi R, Patel V, Shah P. Comparison of in-hospital outcomes between octogenarians and nonagenarians undergoing transcatheter aortic valve replacement: a propensity matched analysis. J Geriatr Cardiol, 2018, 15(2): 123-130.
15. Escárcega RO, Baker NC, Lipinski MJ, et al. Clinical profiles and correlates of mortality in nonagenarians with severe aortic stenosis undergoing transcatheter aortic valve replacement. Am Heart J, 2016, 173: 118-125.
16. Ichimoto E, Arnofsky A, Wilderman M, et al. Early mortality and safety after transcatheter aortic valve replacement using the SAPIEN 3 in nonagenarians. J Geriatr Cardiol, 2018, 15(6): 387-393.
17. Miura M, Shirai S, Uemura Y, et al. Early safety and efficacy of transcatheter aortic valve implantation for Asian nonagenarians (from KMH Registry). Int Heart J, 2017, 58(6): 900-907.
18. Scholtz S, Dimitriadis Z, Vlachojannis M, et al. Transcatheter aortic valve implantation in nonagenarians: procedural outcome and mid-term results. Heart Lung Circ, 2018, 27(6): 725-730.
19. Vendrik J, van Mourik MS, van Kesteren F, et al. Comparison of outcomes of transfemoral aortic valve implantation in patients <90 with those >90 years of age. Am J Cardiol, 2018, 121(12): 1581-1586.
20. Vlastra W, Chandrasekhar J, Vendrik J, et al. Transfemoral TAVR in nonagenarians: from the CENTER collaboration. JACC Cardiovasc Interv, 2019, 12(10): 911-920.
21. Yamamoto M, Meguro K, Mouillet G, et al. Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged ≥90 years versus <90 years. Am J Cardiol, 2012, 110(8): 1156-1163.
22. Yamamoto M, Mouillet G, Meguro K, et al. Clinical results of transcatheter aortic valve implantation in octogenarians and nonagenarians: insights from the FRANCE-2 registry. Ann Thorac Surg, 2014, 97(1): 29-36.
23. Yokoyama H, Tobaru T, Muto Y, et al. Long-term outcomes in Japanese nonagenarians undergoing transcatheter aortic valve implantation: A multi-center analysis. Clin Cardiol, 2019, 42(6): 605-611.
24. Writing group members, Lloyd-Jones D, Adams RJ, et al. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation, 2010, 121(7): e46-e215.
25. Levy Praschker BG, Leprince P, Bonnet N, et al. Cardiac surgery in nonagenarians: hospital mortality and long-term follow-up. Interact Cardiovasc Thorac Surg, 2006, 5(6): 696-699.
26. Idoate F, Cadore EL, Casas-Herrero A, et al. Noncoronary vascular calcification, bone mineral density, and muscle mass in institutionalized frail nonagenarians. Rejuvenation Res, 2017, 20(4): 298-308.
27. Mangieri A, Montalto C, Poletti E, et al. Thrombotic versus bleeding risk after transcatheter aortic valve replacement: JACC review topic of the week. J Am Coll Cardiol, 2019, 74(16): 2088-2101.
28. Raheja H, Garg A, Goel S, et al. Comparison of single versus dual antiplatelet therapy after TAVR: A systematic review and meta-analysis. Catheter Cardiovasc Interv, 2018, 92(4): 783-791.
29. Piazza N, Onuma Y, Jesserun E, et al. Early and persistent intraventricular conduction abnormalities and requirements for pacemaking after percutaneous replacement of the aortic valve. JACC Cardiovasc Interv, 2008, 1(3): 310-316.
30. Baan J Jr, Yong ZY, Koch KT, et al. Factors associated with cardiac conduction disorders and permanent pacemaker implantation after percutaneous aortic valve implantation with the CoreValve prosthesis. Am Heart J, 2010, 159(3): 497-503.
31. Bleiziffer S, Ruge H, Hörer J, et al. Predictors for new-onset complete heart block after transcatheter aortic valve implantation. JACC Cardiovasc Interv, 2010, 3(5): 524-530.
32. Calvi V, Puzzangara E, Pruiti GP, et al. Early conduction disorders following percutaneous aortic valve replacement. Pacing Clin Electrophysiol, 2009, 32 (Suppl 1): S126-S130.
33. Erkapic D, Kim WK, Weber M, et al. Electrocardiographic and further predictors for permanent pacemaker requirement after transcatheter aortic valve implantation. Europace, 2010, 12(8): 1188-1190.
34. Jilaihawi H, Chin D, Vasa-Nicotera M, et al. Predictors for permanent pacemaker requirement after transcatheter aortic valve implantation with the CoreValve bioprosthesis. Am Heart J, 2009, 157(5): 860-866.
35. Latsios G, Gerckens U, Buellesfeld L, et al. "Device landing zone" calcification, assessed by MSCT, as a predictive factor for pacemaker implantation after TAVI. Catheter Cardiovasc Interv, 2010, 76(3): 431-439.
36. Khawaja MZ, Rajani R, Cook A, et al. Permanent pacemaker insertion after CoreValve transcatheter aortic valve implantation: incidence and contributing factors (the UK CoreValve Collaborative). Circulation, 2011, 123(9): 951-960.
37. Saia F, Lemos PA, Bordoni B, et al. Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis: prediction of the need for permanent pacemaker using simple baseline and procedural characteristics. Catheter Cardiovasc Interv, 2012, 79(5): 712-719.
38. Ozcan KS, Osmonov D, Altay S, et al. Pacemaker implantation complication rates in elderly and young patients. Clin Interv Aging, 2013, 8: 1051-1054.
39. Mandawat A, Curtis JP, Mandawat A, et al. Safety of pacemaker implantation in nonagenarians: an analysis of the healthcare cost and utilization project-nationwide inpatient sample. Circulation, 2013, 127(14): 1453-1465.
40. Auffret V, Bedossa M, Boulmier D, et al. From FRANCE 2 to FRANCE TAVI: are indications, technique and results of transcatheter aortic valve replacement the same? Presse Med, 2015, 44(7-8): 752-760.
41. Zack CJ, Al-Qahtani F, Kawsara A, et al. Comparative outcomes of surgical and transcatheter aortic valve replacement for aortic stenosis in nonagenarians. Am J Cardiol, 2017, 119(6): 893-899.
42. Chizner MA, Pearle DL, deLeon AC Jr. The natural history of aortic stenosis in adults. Am Heart J, 1980, 99(4): 419-424.
43. George I, Yerebakan H, Kalesan B, et al. Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians. J Thorac Cardiovasc Surg, 2014, 148(4): 1360-1369.
44. Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol, 2017, 69(10): 1313-1346.
45. Okoh AK, Chauhan D, Kang N, et al. The impact of frailty status on clinical and functional outcomes after transcatheter aortic valve replacement in nonagenarians with severe aortic stenosis. Catheter Cardiovasc Interv, 2017, 90(6): 1000-1006.
46. Biancari F, D'Errigo P, Rosato S, et al. Transcatheter aortic valve replacement in nonagenarians: early and intermediate outcome from the OBSERVANT study and meta-analysis of the literature. Heart Vessels, 2017, 32(2): 157-165.
47. McNeely C, Zajarias A, Robbs R, et al. Transcatheter aortic valve replacement outcomes in nonagenarians stratified by transfemoral and transapical approach. Ann Thorac Surg, 2017, 103(6): 1808-1814.
48. Siontis GC, Jüni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: a meta-analysis. J Am Coll Cardiol, 2014, 64(2): 129-140.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content