Abstract 13314: Comparative Meta-Analysis of Balloon-Expandable and Self-Expandable Valves for Transcatheter Aortic Valve Replacement
Background: Balloon-expandable valves (BEV) and self-expandable valves (SEV) are two major types of valves used for transcatheter aortic valve replacement (TAVR). Despite similar efficacy, recent reports have suggested important differences between the two valve types. We conducted a meta-analysis of available studies to compare the safety and efficacy of these two valve types.
Methods: Medline search was conducted using standard search terms to determine eligible studies. Primary outcomes of the meta-analysis included death and stroke at 30 days and 1 year. Analysis was performed for entire cohort and separately for patients undergoing transfemoral TAVR (TF TAVR).
Results: Analysis of entire cohort revealed significantly higher adjusted 30 day mortality in the SEV cohort as compared to the BEV cohort [Incidence rate ratio (IRR) (95% CI): 1.38 (1.12-1.70)]. There was no significant difference in the unadjusted or adjusted incidence of stroke at 30 days between the two study groups. We observed a significantly higher incidence of new pacemaker implantation, aortic regurgitation≤2+ at 30 days, valve embolization, need for >1 valve following SEV implantation as compared to BEV implantation.
Analysis of TF TAVR cohort showed higher 30 day [IRR (95% CI): 1.43 (1.19-1.78)] and 1 year mortality [IRR (95% CI): 1.43 (1.21-1.68)] for SEV compared to BEV (Panel A). There was no significant difference in 30 day and 1 year stroke incidence rate between the two valve types implanted via the TF route (Panel B).
Conclusion: Compared to BEV implantation, SEV implantation was associated with more adverse procedural outcomes. Mortality at 30 days was higher in the SEV group as compared to the BEV group. In addition, stroke risk was similar at 30 day and 1 year follow-up period in the two study groups. Furthermore, when comparing outcomes of the TF cohort, 30-day and 1-year mortality was higher in the SEV group as compared to the BEV group
Author Disclosures: S. Agarwal: None. A. Parashar: None. L.G. Svensson: None. A. Krishnaswamy: None. E.M. Tuzcu: None. S.R. Kapadia: None.
- © 2014 by American Heart Association, Inc.