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Background: With transcatheter aortic valve replacement (TAVR) gaining dominance in the treatment for aortic stenosis, it is crucial to determine which type of valve is most superior long-term. Previous studies have compared shorter term outcomes of the two valves; however, long-term outcomes are yet to be determined. Objectives: This systematic review and meta-analysis evaluate the five-year outcomes of self-expanding valves (SEV), in comparison to balloon-expanding valves (BEV) in an intermediate to high-risk population. Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Seven online databases (PubMed, Embase, Web Of Science, Scopus, Google Scholar, Cochrane, Rowan-Virtua SOM Library) were screened. 15 studies met the inclusion criteria (10,416 TAVR procedures). Mortality, cardiovascular-related mortality, new pacemaker implantation rates, mean aortic gradient, and aortic regurgitation rates were assessed at five years. Results: A lower mean aortic gradient (p < 0.0006, Cohen’s d = 2.86) throughout SEV procedures, and a lower number of new pacemaker implantation rates (p < 0.0001, Cohen’s d = 0.29) from BEV procedures were analyzed. All other outcomes did not yield significant results. Conclusion: TAVR using either SEV or BEV portrayed similar outcomes, with exception to new pacemaker implantation rates and mean aortic gradient. Using BEV to treat aortic stenosis in an intermediate to high-risk population may lower chances of new pacemaker implantation within 5 years, reducing the need for future procedures and their associated risks. Further studies utilizing RCTs would be beneficial in controlling confounding variables, such as surgeon experience, and patient compliance to postoperative instructions.
Elias et al. (Tue,) studied this question.