Network Meta-analysis of Surgical Aortic Valve Replacement and Different Transcatheter Heart Valve Systems for Symptomatic Severe Aortic Stenosis

2021 ◽  
Vol 37 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Hiroki Ueyama ◽  
Toshiki Kuno ◽  
Tomo Ando ◽  
Kentaro Hayashida ◽  
Hisato Takagi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valve ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter 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.

Myval transcatheter heart valve system in the treatment of severe symptomatic aortic stenosis

2021 ◽  
Vol 17 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Samin K Sharma ◽  
Ravinder S Rao ◽  
Manik Chopra ◽  
Anmol Sonawane ◽  
John Jose ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valve ◽  
Future Research ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve

The transcatheter aortic valve replacement (TAVR) is an established treatment for patients with severe symptomatic aortic stenosis (AS) at prohibitive risk for surgery. It is an alternative treatment to surgical aortic valve replacement in patients with AS at intermediate- and high-surgical risk. Although regulatory authorities extend the indications of TAVR to treat patients at low-surgical risk, the limitations of earlier-generation transcatheter heart valve (THV) systems accelerate the development of improved newer generation of THV systems. Myval™ THV (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) is a newer-generation, balloon-expandable TAVR system with features that facilitate accurate positioning of the bioprosthetic valve and favorable procedural and clinical outcomes. This review summarizes existing preclinical and clinical data on Myval THV for the intervention of symptomatic native AS and lays out the plan for future research program.

Abstract 17367: Propitious Temporal Changes in Clinical Outcomes After Transcatheter Compared to Surgical Aortic Valve Replacement; A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ankur Panchal ◽  
Andreas Kyvernitakis ◽  
Mark Doyle ◽  
Robert W Biederman
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Temporal Changes ◽  
Surgical Aortic Valve Replacement ◽  
All Cause Mortality

Introduction: Treatment for severe aortic stenosis has rapidly evolved over the past decade, in both transcatheter aortic valve replacement (TAVR) technique and surgical aortic valve replacement (SAVR), resulting in improved clinical outcomes. We sought to determine and compare the temporal changes and 1-year outcomes between these groups. Methods: We searched the Medline MESH database using the keywords “aortic stenosis”, “atrial fibrillation” and “stroke”. We performed a meta-analysis and created funnel plots to compare TAVR with SAVR population for post-procedural stroke, all-cause and cardiovascular (CV) mortality at 1-year. Results: Out of >50 studies, we included 20 meeting criteria for analysis with total population of >65000 patients, of which 61067 had TAVR and 4162 had SAVR. AFib prevalence was higher in TAVR vs SAVR patients (38% vs 27%; p< 0.0001). By funnel plotting, post-procedural stroke at 1-year was 3.1% in TAVR and 5% in SAVR patients (NS). All-cause mortality at 1 year was 12.5% in TAVR and 10.3 % in SAVR patients, and CV mortality at 1-year was 7.4% in TAVR and 6.2% in SAVR patients (NS for both). Conclusion: While there is a trend over the last 14 years for overall improvement in both SAVR and TAVR outcomes, via meta-analysis, despite a higher prevalence of AFib in TAVR vs SAVR, there is statistical overlap in the confidence intervals supporting no distinct separation in stroke risk, all-cause mortality or adjudicated CV mortality at 1 year between groups. To our knowledge, this represents the largest study over the longest time period that points towards potential benefit at the individual level but as a socio-economic consideration, no distinction between SAVR vs TAVR.

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