Comparison of outcomes in new-generation versus early-generation heart valve in transcatheter aortic valve implantation: A systematic review and meta-analysis |
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| Institution: | 1. Detroit Medical Center/Wayne State University, Division of Cardiology, Detroit, United States;2. Shizuoka Medical Center, Division of Cardiovascular Surgery, Shizuoka, Japan;1. University of Miami/JFK Medical Center, Atlantis, FL, USA;2. MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA;3. Creighton University, School of Medicine, Omaha, NE, USA;4. Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO, USA;5. Jackson Memorial Hospital/University of Miami, Miller School of Medicine, Division of Cardiovascular Medicine, Miami, FL, USA;6. Wayne State University, Detroit Medical Center, Detroit, MI, USA;7. Heartland Cardiology/Wesley Medical Center, University of Kansas School of Medicine, Wichita, KS, USA;1. Division of Cardiology, Department of Internal Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, United States;2. Department of Internal Medicine, East Tennessee State University, VA Building #1, Johnson City, TN, United States;3. Division of Cardiology, Department of Internal Medicine, Texas Tech University, 4800 Alberta, El Paso, TX 79905, United States;1. Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA;2. Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA;3. Department of Internal Medicine, Wayne State University, Detroit, MI, USA;4. Division of Cardiology, Hurley Medical Center, Michigan State University, Flint, MI, USA;5. Brigham and Women''s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA |
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| Abstract: | BackgroundNew-generation (NG) valves for transcatheter aortic valve implantation (TAVI) has recently been widely used in real-world practice, yet its comparative outcomes with early-generation (EG) valves remain under-explored.MethodsAn electronic literature search using PUBMED and EMBASE was conducted from inception to April 2017 for matched-cohort studies. Articles that compared the outcomes of NG vs. EG valves post TAVI with at least one of the following clinical outcome reported were included: all-cause mortality, major or life-threatening bleeding, major vascular complications (MVC), significant (more than moderate) paravalvular regurgitation (PVR), cerebrovascular events, significant (stage 2 or 3) acute kidney injury (AKI) and new permanent pacemaker implantation (PPI) that occurred either in-hospital or within 30-days.ResultsA total of 6 observational matched-cohort studies with 585 and 647 patients included in NG and EG valves, respectively, were included. EG valves were associated with a lower incidence of major or life-threatening bleeding (5.7% vs. 15.7%, p < 0.00001), significant paravalvular regurgitation (5.3% vs. 14.4%, p = 0.001), and significant AKI (4.4% vs. 7.5, p = 0.03). All-cause mortality (3.5% vs. 5.0, p = 0.43), cerebrovascular events (3.4% vs. 2.3%, p = 0.34) and new PPI (11.0% vs. 14.6%, p = 0.52) were similar between the two groups. NG demonstrated lower tendency of MVC (2.5% vs. 7.2, p = 0.09) compared to EG valves.ConclusionsNG demonstrated lower rates of significant AKI, significant PVR and major or life-threatening bleeding while all-cause mortality, new PPI, and cerebrovascular events remained similar compared to EG valves. |
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