1. Impact of Small Aortic Annuli on the Performance of Transcatheter Aortic Valve Replacement Bioprostheses: An Updated Meta-Analysis of Recent Studies.
- Author
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Di Pietro G, Improta R, Bruno F, De Filippo O, Leone PP, Nebiolo M, Giacobbe F, Caporusso D, Birtolo LI, Ielasi A, Mohamed AW, Ho KW, Meguro K, Ferrara J, Waksman R, Pilgrims T, McKay RG, Seiffert M, Massimo M, De Ferrari GM, and D'Ascenzo F
- Subjects
- Humans, Postoperative Complications epidemiology, Hemodynamics physiology, Bioprosthesis, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Prosthesis Design, Aortic Valve surgery
- Abstract
A metanalysis of available randomized controlled trials and observational studies comparing self-expanding (SE) and balloon-expandable (BE) bioprostheses in patients with small aortic annulus and aortic stenosis for short- and midterm hemodynamic and clinical outcomes was performed. A total of 21 studies with a total 8,647 patients (SE: n = 4,336 patients vs BE: n = 4,311 patients) were included. SE bioprostheses had a lower postoperative mean gradient at 30 days (Mean Difference [MD] -5.16, 95% confidence interval [CI] 4.7 to 5.5, p <0.001) and at 1 year (MD -6.6, 95%CI 6.1 to 7.03, p <0.001), with a larger indexed effective orifice area (0.17, 95% CI 0.13 to 0.22, p <0.001 and 0.17, 95% CI 0.08 to 0.27, p <0.001) at both time intervals. BE bioprostheses had a higher risk of 30-day and 1-year severe prosthesis-patient mismatch (risk ratio [RR] 1.07, 95% CI 1.04 to 1.09, p <0.001; RR 1.07, 95% CI 1.04 to 1.11, p <0.001). The 30-day and 1 year paravalvular leaks (RR 0.99, 95% CI 0.98 to 0.99, p <0.001; RR 0.89, 95% CI 0.82 to 0.95, p <0.001) and permanent pacemaker implantation (RR 0.97, 95% CI 0.94 to 0.99, p 0.01, I2 = 40%,) were lower in the BE group. BE bioprostheses were associated with a lower risk of in-hospital stroke (RR 0.99, 95% CI 0.98 to 1, p = 0.01). In conclusion, in patients with small aortic annulus and aortic stenosis, SE bioprostheses have superior hemodynamic performance but higher rates of paravalvular leak, permanent pacemaker implantation, and in-hospital stroke. BE bioprostheses were associated with a higher risk of severe prosthesis-patient mismatch., Competing Interests: Declaration of competing interest Dr. Thomas Pilgrim reports research, travel or educational grants to the institution without personal remuneration from Biotronik, Boston Scientific, Edwards Lifesciences, and ATSens; speaker fees and consultancy fees to the institution from Biotronik, Boston Scientific, Edwards Lifesciences, Abbott, Medtronic, Biosensors, and Highlife. Dr. Kay Woon Ho received speaker fees from Edwards Lifesciences, Medtronic, and Abbott Vascular. The remaining authors have no competing interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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