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Review
. 2024 May 22;3(7):102146.
doi: 10.1016/j.jscai.2024.102146. eCollection 2024 Jul.

Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding Valves: A Meta-analysis

Saman Asad Siddiqui  1 , Sina Kazemian  2 , Tanush Gupta  3 , Nilay K Patel  1   4 , Rahul Sakhuja  1   4 , Ignacio Inglessis  1   4 , Arminder Jassar  1   5 , Nathaniel Langer  1   5 , Jonathan J Passeri  1   4 , Harold L Dauerman  3 , Sammy Elmariah  6 , Dhaval Kolte  1   4
Affiliations
Review

Outcomes of Transcatheter Aortic Valve Replacement Using Third-Generation Balloon-Expandable Versus Self-Expanding Valves: A Meta-analysis

Saman Asad Siddiqui et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: The choice of transcatheter aortic valve replacement (TAVR) prosthesis is crucial in optimizing short- and long-term outcomes. The objective of this study was to conduct a meta-analysis comparing outcomes of third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).

Methods: Electronic databases were searched from inception to June 2023 for studies comparing third-generation BEV vs SEV. Primary outcome was all-cause mortality. Secondary outcomes included clinical and hemodynamic end points. Random-effects models were used to calculate pooled odds ratios (ORs) or weighted mean differences (WMDs).

Results: The meta-analysis included 16 studies and 10,174 patients (BEV, 5753 and SEV, 4421). There were no significant differences in 1-year all-cause mortality (OR, 1.15; 95% CI, 0.89-1.48) between third-generation BEV vs SEV. TAVR with third generation BEV was associated with a significantly lower risk of TIA/stroke (OR, 0.62; 95% CI, 0.44-0.87), permanent pacemaker implantation (OR, 0.55; 95% CI, 0.44-0.70), and ≥moderate paravalvular leak (PVL, OR, 0.43; 95% CI, 0.25-0.75), and higher risk of ≥moderate patient-prosthesis mismatch (OR, 3.76; 95% CI, 2.33-6.05), higher mean gradient (WMD, 4.35; 95% CI, 3.63-5.08), and smaller effective orifice area (WMD, -0.30; 95% CI, -0.37 to -0.23), compared with SEV.

Conclusion: In this meta-analysis, TAVR with third-generation BEV vs SEV was associated with similar all-cause mortality, lower risk of TIA/stroke, permanent pacemaker implantation, and ≥moderate PVL, but higher risk of ≥moderate patient-prosthesis mismatch, higher mean gradient, and smaller effective orifice area. Large, adequately powered randomized trials are needed to evaluate long-term outcomes of TAVR with latest generations of BEV vs SEV.

Keywords: balloon-expandable valve; outcomes; self-expanding valve; transcatheter aortic valve replacement.

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Figures

Figure 1
Figure 1
One-year all-cause mortality (A) and heart failure hospitalization (B) after TAVR with third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).
Figure 2
Figure 2
In-hospital or 30-day all-cause mortality (A) and myocardial infarction (B) after TAVR with third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).
Figure 3
Figure 3
In-hospital or 30-day transient ischemic attack (TIA)/stroke (A) and permanent pacemaker implantation (B) after TAVR with third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).
Figure 4
Figure 4
In-hospital or 30-day moderate/severe paravalvular leak (PVL) (A) and moderate/severe patient-prosthesis mismatch (PPM) (B) after TAVR with third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).
Figure 5
Figure 5
In-hospital or 30-day mean aortic valve (AV) gradient (A) and effective orifice area (B) after TAVR with third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV).
Central Illustration
Central Illustration
Meta-analysis of studies comparing outcomes of third-generation balloon-expandable valves (BEV) vs self-expanding valves (SEV). AV, aortic valve; PPM, patient-prosthesis mismatch; PVL, paravalvular leak; TIA, transient ischemic attack.
See this image and copyright information in PMC

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