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T ranscatheter aortic valve replacement for stenotic bicuspid aortic valves: S ystematic review and meta analyses of observational studies
Author(s) -
Reddy Gautam,
Wang Zhen,
Nishimura Rick A.,
Greason Kevin L.,
Yoon SungHan,
Makkar Raj R.,
Holmes David R.
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27340
Subject(s) - medicine , observational study , stenosis , cardiology , valve replacement , bicuspid aortic valve , confidence interval , incidence (geometry) , aortic valve stenosis , aortic valve replacement , context (archaeology) , aortic valve , surgery , paleontology , physics , optics , biology
Objective The aim of this study was to perform a systematic review and meta‐analyses of observational studies of transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve stenosis (BcAV). Background TAVR for BcAV stenosis has been associated with an increased incidence of paravalvular leaks, valve malposition, pacemaker placement and all‐cause mortality. The conclusions drawn have been limited by small sample sizes. The use of TAVR for BcAV stenosis remains controversial. Methods We searched multiple databases from the inception of the databases through September 30, 2016 for studies of TAVR for BcAV stenosis. We included all observational studies with more than one patient and at least 1 month of outcomes. Results We analyzed 13 observational studies with 758 patients. Meta analyses showed device success rate of 95% [95% confidence interval (CI) 90.2% to 98.5%] and an early safety event in 16.9% [95% CI 12.2% to 22%]. At 30 days, moderate to severe paravalvular leak was seen in 12.2% [95% CI 3.1% to 24.8%] and new pacemaker implantation in 17.9% [95% CI 14.2% to 22%]. All‐cause mortality was 3.7% [95% CI 2.1% to 5.6%], which should be viewed in the context of an STS PROM of 5.0%. Conclusions This analysis suggests that TAVR for BcAV is not associated with excess mortality. The incidence of paravalvular leaks and pacemaker implant is increased compared to tricuspid aortic valve cohorts undergoing TAVR, and operators should weigh these potential complications against the clinical benefit provided by TAVR for BcAV patients at high risk for surgical valve replacement.