Comparison of Procedural Outcomes in Transcatheter Aortic Valve Replacement
Published Date: 01st October 2020
Publication Authors: Akhtar KJ
Background
Mechanically expanded valve (MEV) was designed to reduce paravalvular leak and to provide the ability to reposition during transcatheter aortic valve replacement (TAVR). We have assessed recent evidence on procedural outcomes between MEV and the self-expandable valve (SEV).
Methods
Two independent researchers performed an extensive search on PubMed and Ovid using keywords mechanically expanded, self-expandable and TAVR yielding 530 studies. Ten studies with a total of 4,574 patients met the inclusion criteria. We compared procedural and device outcomes including paravalvular leak, post-implant balloon dilatation, implantation of >1 valve, prosthetic valve regurgitation > grade 2/4, periprocedural myocardial infarction, and procedural mortality. The results are reported as odds ratio (OR), 95% confidence interval (CI), and p < 0.05.
Results
In 4,574 patients undergoing TAVR, MEV and SEV were implanted in 1,038 and 3,536 patients, respectively. MEV had a statistically significant decrease in paravalvular leak (OR: 0.15; 95% CI: 0.04 to 0.64; p = 0.01), post-implant balloon dilatation (OR: 0.08; 95% CI: 0.02 to 0.27; p < 0.0001), implantation of >1 valve (OR: 0.20; 95% CI: 0.05 to 0.73; p = 0.02), and prosthetic valve regurgitation > grade 2/4 (OR: 0.22; 95% CI: 0.10 to 0.48; p = 0.0002 ) (Figures 1A, 1B, 1C, and 1D, respectively). Periprocedural myocardial infarction (OR: 0.56; 95% CI: 0.15 to 2.06; p = 0.38) and procedural mortality (OR: 1.81; 95% CI: 0.23 to 14.10; p = 0.57) (Figures 1E and 1F, respectively) showed no statistically significant difference.
Conclusion
TAVR with MEV provides better procedural and device outcomes as compared to SEV.
Hafeez, H; Akhtar, KJ et al. (2020). TCT CONNECT-127 Comparison of Procedural Outcomes in Transcatheter Aortic Valve Replacement With Mechanically Expanded Valve Versus Self-Expandable Valve: A Systematic Review and Meta-Analysis. Journal of the American College of Cardiology. 76 (17S), B56