Balloon-expandable versus self-expanding transcatheter aortic valve replacement for bioprosthetic dysfunction: A systematic review and meta-analysis

PLoS One. 2020 Jun 1;15(6):e0233894. doi: 10.1371/journal.pone.0233894. eCollection 2020.

Abstract

Background: Transcatheter aortic valve-in-valve (VIV) procedure is a safe alternative to conventional reoperation for bioprosthetic dysfunction. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the 2 major types of devices used. Evidence regarding the comparison of the 2 valves remains scarce.

Methods: A systematic review and meta-analysis was conducted to compare the outcomes of BEV and SEV in transcatheter VIV for aortic bioprostheses dysfunction. A computerized search of Medline, PubMed, Embase, and Cochrane databases was performed. English-language journal articles reporting SEV or BEV outcomes of at least 10 patients were included.

Results: In total, 27 studies were included, with 2,269 and 1,671 patients in the BEV and SEV groups, respectively. Rates of 30-day mortality and stroke did not differ significantly between the 2 groups. However, BEV was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001). Regarding echocardiographic parameters, SEV was associated with larger postprocedural effective orifice area at 30 days (1.53 cm2 vs. 1.23 cm2; P < 0.001) and 1 year (1.55 cm2 vs. 1.22 cm2; P < 0.001).

Conclusions: For patients who underwent transcatheter aortic VIV, SEV was associated with larger postprocedural effective orifice area but higher rates of permanent pacemaker implantation. These findings provide valuable information for optimizing device selection for transcatheter aortic VIV.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Aortic Valve / surgery*
  • Bioprosthesis / adverse effects*
  • Clinical Decision-Making
  • Heart Valve Prosthesis / adverse effects*
  • Humans
  • Pacemaker, Artificial / statistics & numerical data
  • Prosthesis Failure*
  • Reoperation / instrumentation
  • Reoperation / methods
  • Transcatheter Aortic Valve Replacement / instrumentation*
  • Transcatheter Aortic Valve Replacement / methods
  • Treatment Outcome

Grants and funding

This work was supported by a grant from Chang Gung Memorial Hospital, Taiwan CMRPG3H1511 (SWC), CMRPG 3J0661 (SWC), and BMRPD95 (SWC). This work was also supported by Ministry of Science and Technology grants MOST 107-2314-B-182A-152 and MOST 108-2314-B-182A-141 (SWC). The authors are thankful for the statistical assistance provided by and acknowledge the support of the Maintenance Project of the Center for Big Data Analytics and Statistics (grant CLRPG3D0045) at Chang Gung Memorial Hospital for statistical consultation and data analysis. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.