Key result
TAVR valves <26 mm linked to ~257% higher SVD risk, whereas oral anticoagulants lower risk.
Why the study?
The durability of transcatheter aortic valves is increasingly important as TAVR is offered to low-risk patients with longer life expectancy.
Meta-Analysis
Structural valve deterioration is infrequent >5 years post-TAVR, but is more common in patients with renal dysfunction, smaller valve diameters (<26 mm), and those not on oral anticoagulants.
May inform TAVR valve selection and anticoagulation decisions; extends meta-analytic evidence on SVD predictors.
BACKGROUND: Transcatheter aortic valve replacement (TAVR), widely used as an alternative therapy in patients with severe aortic stenosis, is expected to be offered to low-risk patents with a longer life expectancy. The durability of transcatheter aortic valve is becoming of increasing importance. METHOD: PubMed, Embase, and Cochrane CENTRAL from the inception to March 2020 were systematically screened for studies reporting on structural valve deterioration (SVD) in TAVR patients. Incidence of SVD was diagnosed according to the latest European consensus as the primary end point. Predictors of SVD evaluated at multivariable analysis and cumulative incidence function (CIF) of SVD were the secondary end point. RESULT: = 86%) in the long term (≥5 years). Subgroup analysis was performed to identify the valve type that may result in partial heterogeneity. SVD was more frequent in patents with a valve diameter of <26 mm (HR: 3.57, 1.47-8.69), oral anticoagulants (OAC), exposure at discharge (OR: 0.48, 0.38-0.61), or by a disease of renal dysfunction (OR 1.42, 1.03-1.96). CONCLUSION: SVD represents infrequent events after TAVR in the long term (>5 years), occurring more commonly in renal dysfunction patients, with small valve diameter and without OAC exposure. There may be an underestimation of the incidence if we assume death as a competing risk.
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Long et al. (2020) conducted a meta-analysis in Severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) was evaluated on Incidence of structural valve deterioration (SVD). Structural valve deterioration after TAVR was more frequent with valve diameter <26 mm (HR 3.57; 95% CI 1.47-8.69) and renal dysfunction, but less frequent with oral anticoagulants (OR 0.48).
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