Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Abstract

Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

Trends and Outcomes of Aortic Valve Replacement in Patients With Diabetes in the US

“…Subsequently, studies proved the superiority of TAVR in high-risk patients (17), non-inferior in intermediate-risk (18), and superior in low-risk patients (19). We recently showed that most post-procedural aortic valve function parameters assessed by echocardiography also favor TAVR (20). With newer studies proving not only safety but also the superiority of TAVR as an alternative to sAVR among patients with diverse surgical risk profiles (17)(18)(19), the proportion of TAVR procedures relative to sAVR procedures conducted annually is on the rise, as seen in our study in both diabetes and non-diabetes patients.…”

Oxidative Stress in Calcific Aortic Valve Stenosis: Protective Role of Natural Antioxidants

“…Both valve replacement procedures give rise to the most common problem—prosthetic mismatch—which can lead to bioprosthetic valve dysfunction, diminished regression of the left ventricular mass, symptoms recurrence, and unfavorable clinical outcomes [ 21 ]. Therefore, it is crucial to find treatment alternatives to alleviate aortic valve stenosis due to various risk factors and complications.…”