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Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta‐analysis
Author(s) -
Rawasia Wasiq Faraz,
Khan Muhammad Shahzeb,
Usman Muhammad Shariq,
Siddiqi Tariq Jamal,
Mujeeb Firzah Abdul,
Chundrigar Mohsin,
Kalra Ankur,
Alkhouli Mohamad,
Kavinsky Clifford J,
Bhatt Deepak L.
Publication year - 2019
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.27840
Subject(s) - medicine , meta analysis , valve replacement , cardiology , myocardial infarction , regurgitation (circulation) , stroke (engine) , aortic valve , subgroup analysis , surgery , aortic valve replacement , stenosis , mechanical engineering , engineering
Objective The objective of this study was to analyze the available literature on using transcatheter aortic valve replacement (TAVR) for native aortic regurgitation (AR). Background Surgical aortic valve replacement is the gold standard therapy for native AR. TAVR has emerged as an alternative approach in high‐risk patients. Methods MEDLINE, Scopus, and Cochrane CENTRAL were searched for reports of at least 5 patients undergoing TAVR for native AR. Outcomes included 30‐day mortality, myocardial infarction, stroke, major bleeding, postprocedural moderate to severe AR, and device success. Pooled estimates were calculated using a random‐effects model. Subgroup analysis and a meta‐regression were performed to study the effects of study level covariates on outcomes. Results Nineteen studies ( n =998 patients) were included. The rate of procedural success per Valve Academic Research Consortium – 2 (VARC‐2) criteria was 86.2% (78.8%–92.2%]. Thirty‐day mortality was 11.9% (9.4%–14.7%). Subgroup analysis showed the use of new generation valves was associated with lower 30‐day mortality ( P = 0.02) and higher device success ( P = 0.009) compared with early generation valves. There was no significant difference ( P = 0.13) in the rate of 30‐day mortality between patients receiving purpose‐specific [8.2% (4.3%−13.1%); I2 = 0%] and nonpurpose specific valves [13.0% (8.2%–18.6%); I2 = 25%]. However, device success was higher ( P = 0.02) in patients who received purpose‐specific valves [96.3% (92.2%−98.9%); I2 = 0%] compared with nonpurpose specific valves [84.4% (75%−91.9%); I2 =46%]. Conclusion TAVR for native AR is associated with acceptable procedural success but increased early mortality. However, the safety and the efficacy of the procedure increased with newer valves.