Transcatheter aortic valve implantation in aortic regurgitation versus aortic stenosis: a systematic review and meta-analysis

Background At present, there is no comparative assessment of pooled clinical outcomes between patients with aortic valve regurgitation (AR) and those with aortic valve stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). Purpose A systematic review to examine the clinical outcomes of TAVI in patients with AR compared to those with AS. Methods A meta-analysis was conducted according to the Cochrane Handbook and the PRISMA statement. A comprehensive systematic electronic literature search was conducted from inspection to June 11, 2025. RStudio software was used to calculate the pooled odds ratio (OR) with 95% confidence intervals (95% CI). A Random-effects model was used to allow a more conservative approach. A p-value of <0.05 was set as the statistical significance. Results Nine cohort observational studies were included. Overall, baseline characteristics did not differ between the comparison groups. In patients with AR, TAVI was associated with significantly higher rates of conversion to open heart surgery (OR 3.63, 95% CI: 2.23; 5.91), bleeding (OR 1.23, 95% CI: 1.01; 1.51), and all-cause death (OR 2.00, 95% CI: 1.25; 3.20) than those with AS post procedure before hospital discharge. There was no difference between the groups in terms of procedure success, presence of paravalvular leak, need for a second device or permanent pacemaker (PPM), stroke, or length of hospital stay. Outcomes at 30-days and longer-term follow-up did not differ between the groups in terms of the need for PPM, aortic valve re-intervention, stroke, and death (Figure 1). Conclusion TAVI in patients with AR was associated with worse post procedural outcomes but not at follow-up. Future investigations are warranted to identify potential risk factors in patients with AR to ensure post procedure safety.