Meta-analysis Comparing Transcatheter and Surgical Treatments of Paravalvular Leaks

Tatiana Busu, Fahad Alqahtani, Vinay Badhwar, Chris C. Cook, Charanjit S. Rihal, Mohamad Alkhouli

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Percutaneous paravalvular leak (PVL) closure has emerged as a feasible alternative to redo valve surgery. However, comparative data on percutaneous and surgical treatment of PVL are scarce. We performed a systematic review and a meta-analysis of studies on percutaneous and surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible studies were analyzed. Primary end points were technical success, 30-day mortality, stroke, and length of stay. Secondary end points were 1-year mortality, readmission for heart failure, reoperation, and symptomatic improvement at follow-up. A total of 2,373 patients were included, of whom 1,511 (63.7%) underwent percutaneous closure. Technical success was higher with surgery (96.7% vs 72.1%, odds ratio [OR] 9.7, p <0.001) but at the cost of higher 30-day mortality (8.6% vs 6.8%, OR 1.90, p <0.001), a trend toward higher stroke (3.3% vs 1.4%, OR 1.94, p = 0.069), and longer hospitalizations. However, surgery was associated with similar 1-year mortality (17.3% vs 17.2%, OR 1.07, p = 0.67), reoperation (9.1% vs 9.9%, OR 0.72, p = 0.1), readmission for heart failure (13.3% vs 26.4%, OR 0.51, p = 0.29), and improvement in New York Heart Association classification (67.4% vs 56%, OR 1.37, p = 0.74), compared with percutaneous closure. A sensitivity analysis including comparative studies only yielded similar results. Surgical treatment of PVL achieves higher technical success rates but is associated with higher early morbidity and mortality compared with percutaneous closure. Nevertheless, mortality rates and clinical efficacy parameters were similar at midterm with both procedures. Further studies are warranted to identify the ideal management approach to patients with symptomatic PVL.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

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Meta-Analysis
Odds Ratio
Mortality
Reoperation
Therapeutics
Heart Failure
Stroke
Length of Stay
Hospitalization
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Meta-analysis Comparing Transcatheter and Surgical Treatments of Paravalvular Leaks. / Busu, Tatiana; Alqahtani, Fahad; Badhwar, Vinay; Cook, Chris C.; Rihal, Charanjit S.; Alkhouli, Mohamad.

In: American Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Busu, Tatiana ; Alqahtani, Fahad ; Badhwar, Vinay ; Cook, Chris C. ; Rihal, Charanjit S. ; Alkhouli, Mohamad. / Meta-analysis Comparing Transcatheter and Surgical Treatments of Paravalvular Leaks. In: American Journal of Cardiology. 2018.
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abstract = "Percutaneous paravalvular leak (PVL) closure has emerged as a feasible alternative to redo valve surgery. However, comparative data on percutaneous and surgical treatment of PVL are scarce. We performed a systematic review and a meta-analysis of studies on percutaneous and surgical treatments of PVL. Of the 2,267 studies screened, 22 eligible studies were analyzed. Primary end points were technical success, 30-day mortality, stroke, and length of stay. Secondary end points were 1-year mortality, readmission for heart failure, reoperation, and symptomatic improvement at follow-up. A total of 2,373 patients were included, of whom 1,511 (63.7{\%}) underwent percutaneous closure. Technical success was higher with surgery (96.7{\%} vs 72.1{\%}, odds ratio [OR] 9.7, p <0.001) but at the cost of higher 30-day mortality (8.6{\%} vs 6.8{\%}, OR 1.90, p <0.001), a trend toward higher stroke (3.3{\%} vs 1.4{\%}, OR 1.94, p = 0.069), and longer hospitalizations. However, surgery was associated with similar 1-year mortality (17.3{\%} vs 17.2{\%}, OR 1.07, p = 0.67), reoperation (9.1{\%} vs 9.9{\%}, OR 0.72, p = 0.1), readmission for heart failure (13.3{\%} vs 26.4{\%}, OR 0.51, p = 0.29), and improvement in New York Heart Association classification (67.4{\%} vs 56{\%}, OR 1.37, p = 0.74), compared with percutaneous closure. A sensitivity analysis including comparative studies only yielded similar results. Surgical treatment of PVL achieves higher technical success rates but is associated with higher early morbidity and mortality compared with percutaneous closure. Nevertheless, mortality rates and clinical efficacy parameters were similar at midterm with both procedures. Further studies are warranted to identify the ideal management approach to patients with symptomatic PVL.",
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