Balloon-expandable, self-expanding valves comparable for TAVI

Transcatheter aortic valve implantation (TAVI) with either balloon-expandable valves (BEVs) or self-expanding valves (SEVs) yields comparable outcomes, according to a new meta-analysis.

Accessing the databases of PubMed, the Cochrane Library and Embase through 31 March 2019, researchers retrieved eight randomized controlled trials for inclusion in the Bayesian network meta-analysis. The primary outcome of interest was all-cause mortality at the latest follow-up, while secondary outcomes included long-term cardiovascular mortality, stroke, pacemaker implantation, among other vascular events.

The pooled sample included 8,095 patients, of whom 1,976, 2,256 and 3,863 received BEV, SEV and surgical aortic valve replacement, respectively.

Researchers detected no significant difference between BEV and SEV in terms of 30-day all-cause mortality (odds ratio [OR], 0.85, 95 percent CI, 0.34–1.99), cardiovascular mortality (OR, 1.3, 0.58–2.50), stroke (OR, 1.59, 0.37–6.71), bleeding (OR, 0.85, 0.34–1.99) and major vascular complications (OR, 1.30, 0.58–2.50).

Both interventions were likewise comparable for short-term, 30-day moderate to severe paravalvular leak (OR, 0.28, 0.06–1.22).

Long-term outcomes were also similar between BEV and SEV: all-cause mortality (hazard ratio [HR], 1.1, 0.87–1.5), cardiovascular mortality (HR, 1.1, 0.73–1.6), stroke (HR, 1.3, 0.73–2.1), hospitalization (HR, 0.87, 0.41–1.6) and reintervention (HR, 0.68, 0.2–2.3).

Only the difference in the need for new pacemaker reimplantation, both in the short-term (OR, 0.29, 0.11–0.77) and long-term (HR, 0.45, 0.24–0.80) achieved statistical significance, such that BEV patients were less likely to require it.