TY - JOUR
T1 - Transcatheter aortic valve replacement in mixed aortic valve disease
T2 - A systematic review and meta-analysis
AU - Guddeti, Raviteja R.
AU - Gill, Gauravpal S.
AU - Garcia-Garcia, Hector M.
AU - Alla, Venkata Mahesh
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Utilization of transcatheter aortic valve replacement (TAVR) has expanded from high-risk patients to intermediate- A nd select low-risk candidates with severe aortic stenosis (AS). TAVR is currently not indicated for patients with aortic insufficiency, and its outcomes in mixed aortic valve disease (MAVD) are unclear. Methods: A systematic search of PubMed, Medline, CINHAL, and Cochrane databases was performed to identify studies comparing TAVR outcomes in patients with AS vs. MAVD. Primary outcomes included 30-day and late all-cause mortality, and paravalvular regurgitation (PVR). Secondary outcomes were major bleeding, vascular complications, device implantation success, permanent pacemaker, and stroke. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Der Simonian-Laird random-effects model. Results: Six observational studies with 58 879 patients were included in the analysis. There was no significant difference in 30-day all-cause mortality [OR 1.03 (95% CI 0.92-1.15); P = 0.63], however, MAVD group had higher odds of moderate-to-severe PVR [1.81 (1.41-2.31); P < 0.01]. MAVD patients had lower odds of device implantation success [0.60 (0.40-0.91); P = 0.02] while other secondary outcomes were similar in the two groups. Conclusions: TAVR in MAVD is associated with increased odds of paravalvular regurgitation and lower odds of device implantation success when compared to severe aortic stenosis.
AB - Background: Utilization of transcatheter aortic valve replacement (TAVR) has expanded from high-risk patients to intermediate- A nd select low-risk candidates with severe aortic stenosis (AS). TAVR is currently not indicated for patients with aortic insufficiency, and its outcomes in mixed aortic valve disease (MAVD) are unclear. Methods: A systematic search of PubMed, Medline, CINHAL, and Cochrane databases was performed to identify studies comparing TAVR outcomes in patients with AS vs. MAVD. Primary outcomes included 30-day and late all-cause mortality, and paravalvular regurgitation (PVR). Secondary outcomes were major bleeding, vascular complications, device implantation success, permanent pacemaker, and stroke. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Der Simonian-Laird random-effects model. Results: Six observational studies with 58 879 patients were included in the analysis. There was no significant difference in 30-day all-cause mortality [OR 1.03 (95% CI 0.92-1.15); P = 0.63], however, MAVD group had higher odds of moderate-to-severe PVR [1.81 (1.41-2.31); P < 0.01]. MAVD patients had lower odds of device implantation success [0.60 (0.40-0.91); P = 0.02] while other secondary outcomes were similar in the two groups. Conclusions: TAVR in MAVD is associated with increased odds of paravalvular regurgitation and lower odds of device implantation success when compared to severe aortic stenosis.
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U2 - 10.1093/ehjqcco/qcab080
DO - 10.1093/ehjqcco/qcab080
M3 - Article
C2 - 34788825
AN - SCOPUS:85125552865
VL - 8
SP - 169
EP - 176
JO - European heart journal. Quality of care & clinical outcomes
JF - European heart journal. Quality of care & clinical outcomes
SN - 2058-5225
IS - 2
ER -