Efficacy and safety of transcatheter aortic valves in patients with aortic stenosis: a network meta-analysis

Background Patients with aortic stenosis have a high mortality risk treatable by transcatheter aortic valve replacement (TAVR). We conducted a network meta-analysis to compare the efficacy and safety of transcatheter aortic valves in aortic stenosis patients.Methods A systematic search of PubMed, Embase, and Cochrane was conducted. Randomized controlled trials (RCTs) that included adult patients with aortic stenosis undergoing TAVR, which compared clinical efficacy and safety between any of the transcatheter aortic valves, were included. Random effects meta-analysis was employed.Results A total of 4687 patients from 9 RCTs were included. Sapien XT had a significantly higher risk of stroke compared to Sapien 3 RR = 31.38 (95% CI: 1.12 to 876, p = 0.043), while other devices showed no significant differences. Evolut had a significantly increased risk of permanent pacemaker placement compared to Sapien 3 RR = 1.36 (95% CI: 1.07–1.74, p = 0.013). No significant differences were observed between valves for any of the other analyzed outcomes.Conclusion While most TAVR devices showed comparable safety profiles, Evolut was associated with increased pacemaker implantation risk. The higher stroke risk with Sapien XT should be interpreted with caution.Protocol registration This review was registered with PROSPERO (CRD42024563628).