TAVR with the Lotus valve compared to Sapien 3 reduced the risk of mild paravalvular leak (RR 0.65; 95% CI 0.49-0.85) but increased permanent pacemaker implantation and cerebrovascular events.
Meta-Analysis (n=1,974)
Does TAVR with the Lotus valve compared to the Sapien 3 valve improve procedural, clinical, and functional outcomes in patients with severe native valve stenosis?
Compared to the Sapien 3 valve, the Lotus valve for TAVR reduces mild paravalvular leak but significantly increases the risk of permanent pacemaker implantation and cerebrovascular events.
Effect estimate: RR 0.65 (95% CI 0.49-0.85)
p-value: p=0.002
BACKGROUND: Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) was the main concern with early-generation devices and focused technological improvements. Current systematic review and meta-analysis sought to compare outcomes of TAVR for severe native valve stenosis with next-generation devices: Lotus and Sapien 3. METHODS: Electronic databases were screened for studies comparing outcomes of TAVR with Lotus and Sapien 3. In a random-effects meta-analysis, the pooled incidence rates of procedural, clinical and functional outcomes according to VARC-2 definitions were assessed. RESULTS: Sapien 3 N=1,974) met inclusion criteria. No differences were observed regarding composite endpoints-device success and early safety. Similarly, 30-day mortality, major vascular complications, acute kidney injury and serious bleeding events were similar with both devices. Lotus valve demonstrated 35% reduction of the risk for mild PVL: risk ratio (RR) 0.65, 95% confidence interval (CI): 0.49-0.85, P=0.002; but there were no statistical differences with regard to moderate/severe PVL (RR 0.56, 95% CI: 0.18-1.77, P=0.320). Lotus valves produced significantly higher mean transaortic gradients: mean difference (MD) 0.88 mmHg, 95% CI, 0.24-1.53 mmHg, P=0.007; however, without translation into higher rate of prosthesis-patient mismatch (RR 1.10, 95% CI: 0.82-1.47, P=0.540). As compared to Sapien 3, Lotus device placement was associated with significantly higher rate of permanent pacemaker implantation (RR 2.30, 95% CI: 1.95-2.71, P<0.00001) and cerebrovascular events (RR 1.76, 95% CI: 1.03-2.99, P=0.040). CONCLUSIONS: Lotus valve, as compared with Sapien 3, was associated with lower risk for PVL but higher risk for permanent pacemaker implantation and cerebrovascular events.
Gozdek et al. (2020) conducted a meta-analysis in severe native valve stenosis (n=1,974). Lotus prosthetic valve vs. Sapien 3 prosthetic valve was evaluated on mild paravalvular leak (PVL) (RR 0.65, 95% CI 0.49-0.85, p=0.002). TAVR with the Lotus valve compared to Sapien 3 reduced the risk of mild paravalvular leak (RR 0.65; 95% CI 0.49-0.85) but increased permanent pacemaker implantation and cerebrovascular events.