Outcomes of transcatheter aortic valve implantation in Africa: A systematic review and meta-analysis

Background: Transcatheter Aortic Valve Implantation (TAVI) has become the routine standard of care in patients with severe aortic stenosis and prohibitive surgical risk worldwide. However, data on TAVI outcomes from Africa remain sparse. This study aimed to evaluate the outcomes of TAVI in Africa. Methods: We systematically searched PubMed, Scopus and Embase from inception to August 15th, 2024, in addition to the gray literature, and a single proportion meta-analysis was performed to pool proportions and means of categorical and continuous variables, respectively, with 95 % confidence interval (95 % CI). continuous variable reported as median (interquartile range) was converted into a mean (standard deviation). Inconsistency factor (I2) values greater than 50 % represent high heterogeneity. The analysis was performed by R software (RStudio). Results: Of 177 articles, we identified seven observational studies in Africa (n = 704). The mean age was 79.18 years (95 % CI: 77.26-81.10; I2 = 97 %) and 52 % were male. Procedural success rate in Africa was 91 % (95 % CI: 86 %-94 %; I2 = 38 %), however, In-hospital all-cause mortality was 5.0 % (95 % CI: 3 %-8 %; I2 = 35 %) and all-cause mortality at 1-year follow-up was 11.0 % (95 % CI: 6 %-20 %; I2 = 61 %). In terms of adverse events, PPM was in 7.0 % (4.0-11.0, I2 = 14 %), major bleeding occurred in 8.0 % (4.0-14.0, I2 = 78 %), and stroke/TIA 2.0 % (1.0-4.0), I2 = 41 %). Conclusion: The procedural success is high in Africa, however, the mortality rate and adverse events are notable. More national registries are required to accurately identify these outcomes to improve the healthcare system.