Clinical Outcomes of Incidental Findings in Initial Body Computed Tomography Prior to Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background:
Transcatheter aortic valve replacement (TAVR) is increasingly performed in patient with severe symptomatic aortic valve stenosis and intermediate/high surgical risk. The aim of this meta-analysis is to identify the outcomes of clinically significant incidental finding (CSIF) on computed tomography angiography (CTA) prior to TAVR in this patient population.

Methods:
A systematic literature search was performed in accordance to PRISMA guidelines using PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov, and the Cochrane Library databases for studies comparing long-term outcomes of patients with and without CSIF on CTA prior to TAVR.

Results:
Data from 6 studies (n = 2269 patients) were analyzed. The overall prevalence of CSIF (e.g. aortic aneurysm & pulmonary or kidney mass) and highly suspicious malignant findings were 23.4% and 3.3%, respectively. Analysis of 1-year mortality in TAVR patients (n = 2269 patients) showed no significant difference between patients with CSIF and without CSIF (RR: 0.97; 95% CI, 0.69-1.37; p = 0.87). There was no significant difference in the mean time from CTA scanning to therapeutic decision (TAVR) in patients with CSIF and without CSIF (mean difference: 2.35; 95% CI, -0.91-5.62; p = 0.16). Among patients with CSIF evaluated for TAVR, TAVR was associated with lower 1-year mortality compared to no TAVR (17% vs 49%, p <0.0001).

Conclusions:
There was no significant difference in 1-year mortality in patients with and without CSIF undergoing TAVR. This suggested that CSIF detected during TAVR evaluation should not be an absolute contraindication for TAVR.