Key result
TAVR in mixed aortic valve disease had similar 30-day mortality to severe aortic stenosis (OR 1.03; 95% CI 0.92-1.15; P=0.63) but higher odds of moderate-to-severe paravalvular regurgitation.
Why the study?
TAVR is not currently indicated for aortic insufficiency, and its clinical outcomes in mixed aortic valve disease remain unclear.
Does TAVR in mixed aortic valve disease compared to severe aortic stenosis affect mortality and paravalvular regurgitation?
Meta-Analysis (n=58,879)
Does TAVR in mixed aortic valve disease compared to severe aortic stenosis affect mortality and paravalvular regurgitation?
Odds Ratio: 1.03 (95% CI 0.92–1.15)
p-value: p=0.63
TAVR in mixed aortic valve disease yields similar 30-day mortality to severe aortic stenosis but carries a higher risk of paravalvular regurgitation and lower device success.
BACKGROUND: Utilization of transcatheter aortic valve replacement (TAVR) has expanded from high-risk patients to intermediate- and select low-risk candidates with severe aortic stenosis (AS). TAVR is currently not indicated for patients with aortic insufficiency, and its outcomes in mixed aortic valve disease (MAVD) are unclear. METHODS: A systematic search of PubMed, Medline, CINHAL, and Cochrane databases was performed to identify studies comparing TAVR outcomes in patients with AS vs. MAVD. Primary outcomes included 30-day and late all-cause mortality, and paravalvular regurgitation (PVR). Secondary outcomes were major bleeding, vascular complications, device implantation success, permanent pacemaker, and stroke. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Der Simonian-Laird random-effects model. RESULTS: Six observational studies with 58 879 patients were included in the analysis. There was no significant difference in 30-day all-cause mortality [OR 1.03 (95% CI 0.92-1.15); P = 0.63], however, MAVD group had higher odds of moderate-to-severe PVR [1.81 (1.41-2.31); P < 0.01]. MAVD patients had lower odds of device implantation success [0.60 (0.40-0.91); P = 0.02] while other secondary outcomes were similar in the two groups. CONCLUSIONS: TAVR in MAVD is associated with increased odds of paravalvular regurgitation and lower odds of device implantation success when compared to severe aortic stenosis.
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Guddeti et al. (2021) conducted a meta-analysis in Mixed aortic valve disease and severe aortic stenosis (n=58,879). TAVR in mixed aortic valve disease vs. TAVR in severe aortic stenosis was evaluated on 30-day all-cause mortality (OR 1.03, 95% CI 0.92-1.15, p=0.63). TAVR in mixed aortic valve disease had similar 30-day mortality to severe aortic stenosis (OR 1.03; 95% CI 0.92-1.15; P=0.63) but higher odds of moderate-to-severe paravalvular regurgitation.
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