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June 13, 2016Journal of the American Heart AssociationOpen Access

Transcatheter Aortic Valve Implantation With or Without Preimplantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta‐Analysis

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Key result

TAVI without BAV shows similar mortality compared to procedures with predilation.

  • RR 0.61
  • 95% CI 0.32-1.14
  • P=0.12
  • n=1,395

Why the study?

Preimplantation balloon aortic valvuloplasty is routinely performed during TAVI, but it is unclear if omitting it affects clinical outcomes such as embolic events or hemodynamic instability.

Does TAVI without preimplantation BAV improve clinical outcomes compared to TAVI with preimplantation BAV in patients undergoing TAVI?

Comparison

TAVI without preimplantation BAV vs TAVI with preimplantation BAV

Design

Systematic review and meta-analysis

Follow-up

30-day

Authors

RBRodrigo BagurCKChun Shing KwokLNLuis Nombela‐Franco

Discussion

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Overview

Supports omitting routine predilation in TAVI; confirms comparable mortality across pooled studies.

Study Design

Type

Meta-Analysis (n=1,395)

Structured PICO

Does TAVI without preimplantation BAV improve clinical outcomes compared to TAVI with preimplantation BAV in patients undergoing TAVI?

P
Population
1,395 patients across 16 studies undergoing transcatheter aortic valve implantation with or without preimplantation balloon aortic valvuloplasty.
I
Intervention
Transcatheter aortic valve implantation (TAVI) without preimplantation balloon aortic valvuloplasty (BAV)
C
Comparator
Transcatheter aortic valve implantation (TAVI) with preimplantation balloon aortic valvuloplasty (BAV)
O
Outcome
Mortality and safety composite end pointhard clinical

Main Result

Relative Risk: 0.61 (95% CI 0.32–1.14)

p-value: p=0.12

TAVI without preimplantation balloon aortic valvuloplasty is associated with similar clinical outcomes and safety profile compared to TAVI with routine preimplantation BAV.

Limitations

  • Further studies including a large number of patients are needed to ascertain the impact of TAVI without preimplantation BAV as a standard practice.
  • small sample size

Cite This Study

Bagur et al. (2016) conducted a meta-analysis in Transcatheter aortic valve implantation (n=1,395). TAVI without preimplantation BAV vs. TAVI with preimplantation BAV was evaluated on mortality (RR 0.61, 95% CI 0.32-1.14, p=0.12). Transcatheter aortic valve implantation without preimplantation balloon aortic valvuloplasty resulted in similar mortality compared to procedures with predilation (RR 0.61; 95% CI 0.32-1.14; P=0.12).

synapsesocial.com/papers/6aacbe61356d077555b0dabdhttps://doi.org/10.1161/jaha.115.003191
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Transfemoral Aortic Valve Implantation of Edwards SAPIEN XT Without Predilatation Is Feasible2014 · 46 citations
  2. 2Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry2011 · 478 citations
  3. 3Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)2012 · 1,612 citations
  4. 4Successful percutaneous management of left main trunk occlusion during percutaneous aortic valve replacement2009 · 69 citations
  5. 5Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2)2012 · 3,374 citations