Transcatheter Aortic Valve Replacement for Mixed Aortic Valve Disease Versus Predominant Aortic Stenosis

We sought to evaluate survival of patients with mixed aortic valve disease (MAVD) versus predominant aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). This was a study-level meta-analysis of reconstructed time-to-event data from nonrandomized studies published by October 2024. Electronic databases were searched for studies with Kaplan-Meier data for overall survival. Individual patient data were reconstructed from published graphs and merged for analysis. Conventional random-effects meta-analysis was conducted for secondary post-TAVR outcomes. Ten studies (5 propensity-matched, 5 unmatched) met inclusion criteria with a total of 7340 patients (4263 AS, 3077 MAVD). MAVD was defined as severe AS with ≥ mild or ≥ moderate concomitant aortic regurgitation in the included studies. At 5 years, there was no difference in survival between patients in the AS group and MAVD group ([hazard ratio (HR) 1.03, 95% confidence interval (CI) 0.94-1.14, p = 0.51]). Sensitivity analysis restricted to studies defining MAVD as ≥ moderate concomitant aortic regurgitation (62% of population) also determined no difference between groups (HR 0.97, 95% CI 0.84-1.12, p = 0.67). When including only propensity-matched studies (35% of population), we observed a significant survival benefit in patients with MAVD (HR 0.79, 95% CI 0.65-0.94, p = 0.01). Patients with MAVD had higher post-TAVR paravalvular leak (RR 1.64, 95% CI 1.15-2.33, p < 0.01). In conclusion, transcatheter aortic valve replacement appears to be safe in patients with MAVD, with similar survival as patients with predominant AS despite higher post-TAVR paravalvular leak. A survival benefit of MAVD is observed after 1 year in propensity-matched studies.