TY - JOUR
T1 - Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation
T2 - A systematic review and meta-analysis
AU - Rawasia, Wasiq Faraz
AU - Khan, Muhammad Shahzeb
AU - Usman, Muhammad Shariq
AU - Siddiqi, Tariq Jamal
AU - Mujeeb, Firzah Abdul
AU - Chundrigar, Mohsin
AU - Kalra, Ankur
AU - Alkhouli, Mohamad
AU - Kavinsky, Clifford J.
AU - Bhatt, Deepak L.
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Objective: The objective of this study was to analyze the available literature on using transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR). Background: Surgical aortic valve replacement is the gold standard therapy for native AR. TAVR has emerged as an alternative approach in high-risk patients. Methods: MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at least 5 patients undergoing TAVR for native AR. Outcomes included 30-day mortality, myocardial infarction, stroke, major bleeding, postprocedural moderate to severe AR, and device success. Pooled estimates were calculated using a random-effects model. Subgroup analysis and a meta-regression were performed to study the effects of study level covariates on outcomes. Results: Nineteen studies (n =998 patients) were included. The rate of procedural success per Valve Academic Research Consortium – 2 (VARC-2) criteria was 86.2% (78.8%–92.2%]. Thirty-day mortality was 11.9% (9.4%–14.7%). Subgroup analysis showed the use of new generation valves was associated with lower 30-day mortality (P = 0.02) and higher device success (P = 0.009) compared with early generation valves. There was no significant difference (P = 0.13) in the rate of 30-day mortality between patients receiving purpose-specific [8.2% (4.3%−13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%–18.6%); I2 = 25%]. However, device success was higher (P = 0.02) in patients who received purpose-specific valves [96.3% (92.2%−98.9%); I2 = 0%] compared with nonpurpose specific valves [84.4% (75%−91.9%); I2 =46%]. Conclusion: TAVR for native AR is associated with acceptable procedural success but increased early mortality. However, the safety and the efficacy of the procedure increased with newer valves.
AB - Objective: The objective of this study was to analyze the available literature on using transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR). Background: Surgical aortic valve replacement is the gold standard therapy for native AR. TAVR has emerged as an alternative approach in high-risk patients. Methods: MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at least 5 patients undergoing TAVR for native AR. Outcomes included 30-day mortality, myocardial infarction, stroke, major bleeding, postprocedural moderate to severe AR, and device success. Pooled estimates were calculated using a random-effects model. Subgroup analysis and a meta-regression were performed to study the effects of study level covariates on outcomes. Results: Nineteen studies (n =998 patients) were included. The rate of procedural success per Valve Academic Research Consortium – 2 (VARC-2) criteria was 86.2% (78.8%–92.2%]. Thirty-day mortality was 11.9% (9.4%–14.7%). Subgroup analysis showed the use of new generation valves was associated with lower 30-day mortality (P = 0.02) and higher device success (P = 0.009) compared with early generation valves. There was no significant difference (P = 0.13) in the rate of 30-day mortality between patients receiving purpose-specific [8.2% (4.3%−13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%–18.6%); I2 = 25%]. However, device success was higher (P = 0.02) in patients who received purpose-specific valves [96.3% (92.2%−98.9%); I2 = 0%] compared with nonpurpose specific valves [84.4% (75%−91.9%); I2 =46%]. Conclusion: TAVR for native AR is associated with acceptable procedural success but increased early mortality. However, the safety and the efficacy of the procedure increased with newer valves.
KW - aortic valve insufficiency
KW - heart diseases
KW - heart valve prosthesis
UR - http://www.scopus.com/inward/record.url?scp=85054310466&partnerID=8YFLogxK
U2 - 10.1002/ccd.27840
DO - 10.1002/ccd.27840
M3 - Review article
C2 - 30269437
AN - SCOPUS:85054310466
SN - 1522-1946
VL - 93
SP - 345
EP - 353
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -