Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation

A systematic review and meta-analysis

Abdullah Haddad, Remy Arwani, Osama Altayar, Tarek Sawas, Mohammad H Murad, Eduardo de Marchena

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

This systematic review and meta-analysis sought to summarize the available evidence on the use of transcatheter aortic valve replacement (TAVR) in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves. Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies. We searched Medline, Embase, Cochrane, and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days. A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4% to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%; I2 = 20.86%). All-cause mortality at 30 days for first generation valves had an incidence rate of 15% (95% CI 10%-20%; I2 = 10%) compared to 7% (95% CI 3%-13%; I2 = 37%) in second generation valves with subgroup interaction analysis P = 0.059. Device success incidence rate in second generation valves was 92% (95% CI 83%-99%; I2 = 67%) vs 68% (95% CI 59%-77%; I2 = 53%) in first generation valves with P = 0.001. TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short-term outcomes.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Aortic Valve Insufficiency
Meta-Analysis
Mortality
Incidence
Heart Valves
Aortic Valve
Surgical Instruments
Databases
Pathology
Equipment and Supplies
Transcatheter Aortic Valve Replacement
Therapeutics

Keywords

  • aortic regurgitation
  • meta-analysis
  • systematic review
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation : A systematic review and meta-analysis. / Haddad, Abdullah; Arwani, Remy; Altayar, Osama; Sawas, Tarek; Murad, Mohammad H; de Marchena, Eduardo.

In: Clinical Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

@article{b91761ee67c446e392f69b2cf66636dd,
title = "Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis",
abstract = "This systematic review and meta-analysis sought to summarize the available evidence on the use of transcatheter aortic valve replacement (TAVR) in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves. Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies. We searched Medline, Embase, Cochrane, and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days. A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4{\%} to 13.1{\%} and Logistic EuroSCORE ranged from 18.2{\%} to 33{\%}. The incidence rate of all-cause mortality at 30 days was found to be 11{\%} (95{\%} CI 7{\%}-16{\%}; I2 = 20.86{\%}). All-cause mortality at 30 days for first generation valves had an incidence rate of 15{\%} (95{\%} CI 10{\%}-20{\%}; I2 = 10{\%}) compared to 7{\%} (95{\%} CI 3{\%}-13{\%}; I2 = 37{\%}) in second generation valves with subgroup interaction analysis P = 0.059. Device success incidence rate in second generation valves was 92{\%} (95{\%} CI 83{\%}-99{\%}; I2 = 67{\%}) vs 68{\%} (95{\%} CI 59{\%}-77{\%}; I2 = 53{\%}) in first generation valves with P = 0.001. TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short-term outcomes.",
keywords = "aortic regurgitation, meta-analysis, systematic review, transcatheter aortic valve replacement",
author = "Abdullah Haddad and Remy Arwani and Osama Altayar and Tarek Sawas and Murad, {Mohammad H} and {de Marchena}, Eduardo",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/clc.23103",
language = "English (US)",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation

T2 - A systematic review and meta-analysis

AU - Haddad, Abdullah

AU - Arwani, Remy

AU - Altayar, Osama

AU - Sawas, Tarek

AU - Murad, Mohammad H

AU - de Marchena, Eduardo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - This systematic review and meta-analysis sought to summarize the available evidence on the use of transcatheter aortic valve replacement (TAVR) in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves. Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies. We searched Medline, Embase, Cochrane, and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days. A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4% to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%; I2 = 20.86%). All-cause mortality at 30 days for first generation valves had an incidence rate of 15% (95% CI 10%-20%; I2 = 10%) compared to 7% (95% CI 3%-13%; I2 = 37%) in second generation valves with subgroup interaction analysis P = 0.059. Device success incidence rate in second generation valves was 92% (95% CI 83%-99%; I2 = 67%) vs 68% (95% CI 59%-77%; I2 = 53%) in first generation valves with P = 0.001. TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short-term outcomes.

AB - This systematic review and meta-analysis sought to summarize the available evidence on the use of transcatheter aortic valve replacement (TAVR) in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves. Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies. We searched Medline, Embase, Cochrane, and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days. A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4% to 13.1% and Logistic EuroSCORE ranged from 18.2% to 33%. The incidence rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%; I2 = 20.86%). All-cause mortality at 30 days for first generation valves had an incidence rate of 15% (95% CI 10%-20%; I2 = 10%) compared to 7% (95% CI 3%-13%; I2 = 37%) in second generation valves with subgroup interaction analysis P = 0.059. Device success incidence rate in second generation valves was 92% (95% CI 83%-99%; I2 = 67%) vs 68% (95% CI 59%-77%; I2 = 53%) in first generation valves with P = 0.001. TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short-term outcomes.

KW - aortic regurgitation

KW - meta-analysis

KW - systematic review

KW - transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=85057543178&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057543178&partnerID=8YFLogxK

U2 - 10.1002/clc.23103

DO - 10.1002/clc.23103

M3 - Article

JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

ER -