Author + information
- Arun Kanmanthareddy1,
- Dixitha Anugula1,
- Sameer Gafoor2,
- Rahul Sharma2,
- Claire Hunter1,
- Scott Lilly3,
- Michael White1,
- Michael Del Core1,
- Himanshu Agarwal1,
- Dennis Esterbrooks1,
- Aryan Mooss1 and
- Venkata Alla1
Transcatheter aortic valve replacement (TAVR) is increasingly being used for high and intermediate surgical risk aortic stenosis patients. Second generation TAVR valves (G2) with improved design have sought to address the drawbacks associated with first generation TAVR valves (G1).
Electronic search of PubMed, EBSCO, Google Scholar databases was performed to identify studies comparing G2 versus G1. Clinical outcomes of vascular complications, bleeding, myocardial infarction (MI), stroke, acute kidney injury (AKI), pacemaker implantation, > mild aortic regurgitation (AR) and mortality were extracted and meta-analysis was performed using STATA 13.0 software. Risk ratio (RR) with 95% confidence intervals (CI) were computed for each outcome.
A Total of 10 studies with 1,871 patients were included in this study. Of these 707 and 1,164 patients were implanted with G2 and G1, respectively. Peri-procedural complications of acute kidney injury, bleeding and vascular complications were remarkably decreased in the G2 group. The risk of MI, stroke and pacemaker implantation were similar in the two groups. The risk of mortality was significantly lower in the G2 group (RR 0.56, 95% CI 0.34 – 0.92). The risk of AR was also remarkably lower in the G2 group (RR 0.32, 95% CI 0.23 – 0.44).
The results of our meta-analysis suggest that the G2 TAVR valves are associated with lower risk of peri-procedural complications, AR and mortality without an antecedent increase in pacemaker implantation.
|Outcome||RR (95% Confidence Intervals)||Heterogeneity|
|Acute kidney injury||0.58 (0.38 - 0.88)||6%|
|Vascular complications||0.36 (0.26 - 0.49)||21%|
|Bleeding||0.46 (0.34 - 0.62)||43%|
|Stroke||0.71 (0.40 - 1.27)||1%|
|Myocardial infarction||0.87 (0.38 - 2.01)||0%|
|Pacemaker implantation||0.99 (0.60 - 1.63)||74%|
|Aortic regurgitation||0.32 (0.23 - 0.44)||0%|
|Mortality||0.56 (0.34 - 0.92)||0%|