Comparison of various transcatheter aortic valves for aortic stenosis – a network meta-analysis of randomized controlled trials

Objectives Our aim was to compare available transcatheter aortic valve replacement (TAVR) valves using direct and indirect evidence from randomized controlled trials (RCT). Background TAVR is now an established treatment for majority of patients with severe aortic stenosis. However, there is limited data comparing various valves. Methods We performed a systematic search of electronic databases for RCT comparing a TAVR valve to a valve or surgery. A Bayesian network meta-analysis was performed to compile evidence from both direct and indirect comparisons at 30 days and at one year. Results Twelve studies with 10,307 patients eligible for TAVR met the criteria and were included. Self-expanding valve CoreValve type (SEV_C) is associated with higher risk of pacemaker implantation and use of >1 valve, SEV Accurate type (SEV_A) is associated with higher risk of ≥ moderate aortic regurgitation (AR) and death, and mechanically expandable valve (MEV) is associated with lower risk of ≥ moderate AR but higher risk of pacemaker at 30 days, SEV_C and MEV were associated with higher pacemaker rates compared balloon expandable valve (BEV) at 1 year. There is no difference among the valves in stroke at 30 days and 1 year. Conclusions At 30 days, BEV was superior on one or more outcomes of mortality, pacemaker implantation, >1 valve implantation, and ≥ moderate AR compared to other valves except the higher rate ≥?moderate AR compared to MEV. At one year, BEV was associated with lower odds of pacemaker implantation compared to SEV_C and MEV but not different on other end points.