TAVR’s significant advance has driven the development of valve technology, which is currently in its third generation.
Even though outcomes have improved, randomized studies are yet to compared balloon-expandable (BEV) vs self-expanding (SEV) valves in randomized studies, and we only have information from different analysis with contradicting conclusions.
This was a meta-analysis of 16 studies including 10,174 patients, 5,753 receiving BEV and 4,421 SEV.
The primary outcome was all cause mortality at one-year follow-up.
Patient mean age was 81, 61% were women, left ventricular ejection fraction was 57% and STS score was 5.1%.
There was no difference in primary end point between both third generation valves (OR, 1.15; CI 95%, 0.89-1.48; P = .29; I2 = 16.4%), or in rehospitalization for cardiac failure (OR, 0.90; CI 95%, 0.65-1.24; P = .50; I2 = 11.5%).
BEV were associated to lower risk of stroke/TIA (OR, 0.62; CI 95%, 0.44-0.87), need for definite pacemaker implantation (OR, 0.55; CI 95%, 0.44-0.70) and moderate paravalvular leaks (OR, 0.43; CI 95%, 0.25-0.75), but also with higher risk of moderate prosthetis mismatch (OR, 3.76; CI 95%, 2.33-6.05), higher mean gradient (DMP, 4.35; CI 95%, 3.63-5.08) and smaller effective area (DMP, -0.30; CI 95%, -0.37 a -0.23) vs SEV.
Conclusion
This meta-analysis has shown that in third generation TAVR, BEV were associated with similar all causer mortality, lower risk of stroke/TIA, need for pacemaker implantation and moderate paravalvular leak, but higher risk of moderate prosthetis mismatch, higher mean gradient and smaller effective area, compared against SEV.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding Valves: A Meta-Analysis.
Reference: Saman Asad Siddiqui, et al.
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