Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies

Max-Paul Winter, Philipp Bartko, Felix Hofer, Martin Zbiral, Achim Burger, Bahil Ghanim, Johannes Kastner, Irene M Lang, Julia Mascherbauer, Christian Hengstenberg, Georg Goliasch

Research output: Journal article (peer-reviewed)Journal article

34 Citations (Scopus)

Abstract

Aim of the present analysis was to collect and pool all available data currently in the literature regarding outcomes and complications of all approved TAVR prosthesis and to assess the transition from first to next generation TAVR devices by directly comparing both in regard of procedure related complications. Transcatheter aortic valve replacement is a well established treatment modality in patients with severe aortic stenosis deemed to be inoperable or at unacceptable risk for open heart surgery. First generation prostheses were associated with a high rate of peri-procedural complications like paravalvular regurgitation, valve malpositioning, vascular complications and conduction disorders. Refinement of the available devices incorporate features to address the limitations of the first-generation devices. A PRISMA checklist-guided systematic review and meta-analysis of prospective observational studies, national and device specific registries or randomized clinical trials was conducted. Studies were identified by searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials and LILACs from January 2000 to October 2017. We extracted and pooled data on both mortality and complications from 273 studies for twelve different valves prostheses in a total of 68,193 patients. In second generation prostheses as compared to first generation devices, we observed a significant decrease in mortality (1.47 ± 1.73% vs. 5.41 ± 4.35%; p < 0.001), paravalvular regurgitation (1.75 ± 2.43vs. 12.39 ± 9.38, p < 0.001) and MACE. TAVR with contemporary next generation devices has led to an impressive improvement in TAVR safety driven by refined case selection, improved procedural techniques and increased site experience.

Original languageEnglish
Article number15568
Pages (from-to)15568
JournalScientific Reports
Volume10
Issue number1
DOIs
Publication statusPublished - 1 Dec 2020

Keywords

  • Aortic Valve/physiopathology
  • Aortic Valve Insufficiency/epidemiology
  • Aortic Valve Stenosis/epidemiology
  • Heart Valve Prosthesis/trends
  • Humans
  • Postoperative Complications/epidemiology
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Transcatheter Aortic Valve Replacement/trends
  • Treatment Outcome

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