The impact of chronic total occlusions in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis

Maximilian Will, Konstantin Schwarz, Thomas Weiss, Gregor Leibundgut, Gudrun Lamm, Paul Vock, Julia Mascherbauer, Chun Shing Kwok

Research output: Journal article (peer-reviewed)Review article

3 Citations (Scopus)


Coronary artery disease (CAD) is frequently encountered in patients evaluated for transcatheter aortic valve replacement (TAVR) due to severe aortic stenosis. The prognostic relevance of chronic total occlusions (CTOs) in this setting is poorly understood. We conducted a search of MEDLINE and EMBASE to identify studies evaluating patients who underwent TAVR and evaluated outcomes depending on the presence of coronary CTOs. Pooled analysis was performed to estimate the rate and risk ratio for mortality. Four studies involving 25,432 patients fulfilled the inclusion criteria. The follow up ranged from in-hospital outcomes to 8-years follow-up. Coronary artery disease was present in 67.8% to 75.5% of patients in 3 studies which reported this variable. The prevalence of CTOs varied between 2% and 12.6% in this cohort. The presence of CTOs was associated with increase in length of stay (8.1 ± 8.2 vs. 5.9 ± 6.5, p < 0.01), cardiogenic shock (5.1% vs. 1.7%, p < 0.01), acute myocardial infarction (5.8% vs. 2.8%, p = 0.02) and acute kidney injury (18.6% vs. 13.9%, p = 0.048). The pooled 1-year death rate revealed 41 deaths in 165 patients in the CTO group and 396 deaths in 1663 patients with no CTO ((24.8%) vs. (23.8%)). The meta-analysis of death with CTO versus no CTO showed a nonsignificant trend toward increased mortality with CTOs (risk ratio 1.11 95% CI 0.90-1.40, I2  = 0%). Our analysis suggests that concomitant CTO lesions in patients undergoing TAVR are common, and its presence was associated with increased in-hospital complications. However, CTO presence by itself was not associated with increased long-term mortality, only a nonsignificant trend toward an increased risk of death in patients with CTO was found. Further studies are warranted to assess the prognostic relevance of CTO lesion in TAVR patients.

Original languageEnglish
Pages (from-to)806-812
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Issue number4
Early online date19 Feb 2023
Publication statusPublished - 01 Mar 2023


  • aortic stenosis (AS)
  • chronic total occlusion (CTO)
  • coronary artery disease (CAD)
  • percutaneous coronary intervention (PCI)
  • trans aortic valve replacement (TAVR)

ASJC Scopus subject areas

  • Radiology, Nuclear Medicine and Imaging
  • Cardiology and Cardiovascular Medicine


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