Abstract 15819: The Outcome of Transcatheter Aortic Valve Replacement for Pure Aortic Regurgitation: A Updated Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Although the current treatment of choice of severe pure aortic regurgitation (AR) is surgical aortic valve replacement, increasing evidence has shown the potential of transcatheter aortic valve replacement (TAVR) in the management of patients who have high surgical risk profiles. AIMS: To conduct a systematic review and meta-analysis in evaluating the outcome of TAVR for pure AR based on current emerging evidence. Methods: Articles on MEDLINE, CINAHL, Web of Science, Embase, and Cochrane that studied the outcome of TAVR for the management of pure native AR were extracted. Device success rates, post-procedure moderate to severe AR rates as well as in-hospital, 30-day, and 1-year all-cause mortality rates were pooled for meta-analysis. Subgroup analyses of the above outcome comparing early-generation devices (EGD) and new-generation devices (NGD) were performed. Data were presented with incidences and 95% confidence intervals (CI), and I 2 was used to analyze heterogeneity. Results: Twenty-four studies involving 4435 patients were included. The pooled device success rate was 89.6% (95% CI 81.7% to 92.2%, I 2 = 91.63%), and 88.2% (95% CI 83.4% to 92.9%, I 2 =86.0%) of device placement was achieved by single implantation. Compare to EGD (72.2%, 95% CI 58.3% to 86.1%, I 2 =94.1%), NGD (91.6%, 95% CI 87.4% to 95.8%, I 2 =83.8%) has a higher device success rate. The overall in-hospital, 30-day, and 1-year all-cause mortality of TAVR for AR was 3.7% (95% CI 2.1% to 5.2%, I 2 =70.2%), 6.9% (95% CI 4.8% to 9.0%, I 2 =79.5%), and 13.9% (95% CI 8.5% to 19.2%, I 2 =89.1%), respectively. A higher 30-day all-cause mortality rate was observed in patients who received EGD implantations (12.6%, 95% CI 7.7% to 17.5%, I 2 =61.4%) than those have NGD placements (6.3%, 95% CI 3.9% to 8.7%, I 2 =51.0%). About 6.9% (95% CI 4.6% to 9.3%, I 2 =72.4%) and 4.6% (95% CI 1.5% to 7.7%, I 2 =86.2%) of patients continue to have moderate to severe AR post-procedure and at 30 days, respectively. CONCLUSION: Our current systematic review and meta-analysis suggests that TAVR may be a feasible option for patients with pure AR who have high surgical risks. NGD is superior to EGD in AR management due to its higher device success rate and favorable mortality outcome.