TAVR in patients with mixed aortic valve disease showed similar mortality to pure aortic stenosis (p>0.05), but a higher risk of paravalvular regurgitation (RR 1.29; 95% CI 1.07-1.55).
Meta-Analysis (n=133,558)
Does transcatheter aortic valve replacement result in similar mortality and complication rates in patients with mixed aortic valve disease compared to pure aortic stenosis?
TAVR in patients with mixed aortic valve disease has similar mortality to pure aortic stenosis, but carries a higher risk of paravalvular regurgitation and vascular complications.
p-value: p=> 0.05
BACKGROUND: Mixed aortic valve disease (MAVD) is defined by the presence of concurrent aortic stenosis (AS) and aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) is effective in MAVD patients with mortality rates comparable to pure aortic stenosis (PAS). While most TAVR complications also occur at similar rates between the MAVD and PAS populations, recent studies have shown conflicting results. METHODS: A systematic literature review was conducted on PubMed and Embase for studies on the outcomes of TAVR in MAVD from inception until May 2024. Primary outcomes were short- and long-term mortality. Secondary outcomes were paravalvular regurgitation (PVR), vascular and bleeding complications, pacemaker implantation, and cerebrovascular complications. A random-effects model was used to pool risk ratios (RR) and 95 % confidence intervals (CI). RESULTS: Eleven observational studies, including 133,558 patients, were included in the analysis. There were no significant differences in primary endpoints (p > 0.05). MAVD was associated with a higher risk of paravalvular regurgitation (RR: 1.29, 95 % CI: 1.07-1.55) and higher risk of vascular complications (RR: 1.20, 95 % CI: 1.01-1.44). No significant differences were noted in other secondary outcomes (p > 0.05), although there was a nonsignificant trend towards a decreased risk of cerebrovascular complications associated with TAVR in MAVD patients. CONCLUSIONS: TAVR is an intervention with similar mortality and complication risk in MAVD and PAS patients. Future research is needed to further clarify the outcomes of TAVR in patients with MAVD, especially regarding cerebrovascular complications, long-term mortality, and the association of paravalvular regurgitation with mortality.
Kidess et al. (Thu,) conducted a meta-analysis in Mixed aortic valve disease (MAVD) (n=133,558). Transcatheter aortic valve replacement (TAVR) vs. Pure aortic stenosis (PAS) was evaluated on Short- and long-term mortality (p=> 0.05). TAVR in patients with mixed aortic valve disease showed similar mortality to pure aortic stenosis (p>0.05), but a higher risk of paravalvular regurgitation (RR 1.29; 95% CI 1.07-1.55).
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