Self-expanding valves showed comparable 30-day all-cause mortality to balloon-expandable valves in ViV-TAVI (3% vs 4%, p=0.44), but higher rates of new permanent pacemaker insertion (9% vs 4%).
Meta-Analysis (n=13,182)
Do self-expanding valves reduce 30-day mortality compared to balloon-expandable valves in patients undergoing valve-in-valve transcatheter aortic valve implantation?
In ViV-TAVI, self-expanding and balloon-expandable valves offer comparable mortality and safety outcomes, though self-expanding valves are associated with a higher risk of new permanent pacemaker insertion.
Absolute Event Rate: 3% vs 4%
p-value: p=0.44
-analysis compares the procedural and clinical outcomes of self-expanding (SE) vs. balloon-expandable (BE) valves in ViV-TAVI. MEDLINE and Scopus were queried to identify studies reporting outcomes of ViV-TAVI by SE/BE valve type or comparing outcomes between SE or BE valves for ViV-TAVI. The primary outcome was incidence of all-cause mortality at 30 days. Data were presented as incidence of outcomes, analyzed via random effects model using inverse variance method with 95 % confidence intervals. Further incidence rates of primary and secondary outcomes were presented as subgroups of BE and SE, with comparison in incidence rates between the subgroups made using p-interaction of proportions. 27 studies with 13,182 patients (SE: 7346; BE: 5836) were included. There were no significant differences between the BE vs. SE valves in 30-day mortality (BE 4 % vs. SE 3 %, p = 0.44), 1-year mortality (BE 12 % vs. SE 10 %, p = 0.60), and moderate-to-severe AR at 1 year (BE 1 % vs. SE 3 %, p = 0.36). However, patients with SE valves had higher rates of new permanent pacemaker insertion (BE 4 % vs. SE 9 %, p = 0.0019). There were no significant differences in the incidence of 30-day safety outcomes, including stroke, AKI, coronary obstruction, major bleeding, and major vascular complications. Both BE and SE valve types showed comparable mortality and safety outcomes in ViV-TAVI, except pacemaker insertion, which was higher in SE compared with BE valves.
Yasmin et al. (Mon,) conducted a meta-analysis in Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) (n=13,182). Self-expanding (SE) valves vs. Balloon-expandable (BE) valves was evaluated on incidence of all-cause mortality at 30 days (p=0.44). Self-expanding valves showed comparable 30-day all-cause mortality to balloon-expandable valves in ViV-TAVI (3% vs 4%, p=0.44), but higher rates of new permanent pacemaker insertion (9% vs 4%).
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