June 7, 2021Scientific ReportsOpen Access

Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

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Why the study?

Although TAVR reduces mortality compared to sAVR, it was unknown which procedure is associated with better post-procedural valvular function.

Does Transcatheter aortic valve replacement (TAVR) improve post-procedural patient-prosthesis-mismatch (PPM) compared to surgical aortic valve replacement (sAVR) in participants with severe aortic stenosis?

Structured PICO

Population

7022 participants with severe aortic stenosis from 6 randomized clinical trials

Intervention

Transcatheter aortic valve replacement (TAVR)

Comparator

Surgical aortic valve replacement (sAVR)

Outcome

post-procedural patient-prosthesis-mismatch (PPM)surrogate

TAVR provides better post-procedural hemodynamics (less patient-prosthesis-mismatch, larger effective orifice area, lower gradients) than sAVR, but is associated with a significantly higher risk of moderate/severe paravalvular leak.

Implication

TAVR may be preferred to minimize PPM in severe AS; confirms hemodynamic advantages over sAVR.

Abstract

Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51-0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73-0.38]) in gradient and an increase of 0.47 (95% CI [0.38-0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12-0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53-16.46]). All results were sustainable at 2 years.