Abstract
Background: In patients with severe aortic stenosis (AS) who are at high risk for surgical aortic valve replacement, transcatheter aortic valve implantation (TAVI) is an emerged alternative procedure. TAVI can be performed using a balloon-expandable Edwards SAPIEN valve (EV) or self-expandable Medtronic CoreValve (CV). The objective of this meta-analysis is to compare post-procedural left ventricular ejection fraction and other echocardiographic valvular performance in patients who underwent TAVI using EV and CV. Methods: PubMed and the Cochrane Center Register of Controlled Trials were searched through May 2014. Eleven studies (n=1513) comparing TAVI procedures that used EV (n=774) and CV (n=739) were included. End points were left ventricular ejection fraction, aortic valve effective orifice area, and mean and peak trans-aortic pressure gradients. The mean difference (MD) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance. Results: There was no significant difference in left ventricular ejection fraction (MD: 1.02, CI: -1.25 to 3.28, p=0.38) and aortic valve effective orifice area (MD: -0.06, CI: -0.17 to 0.06, p=0.04) between EV and CV groups. Mean and peak trans-aortic pressure gradient were significantly higher in CV group compared to EV group (MD: 1.42, CI: 0.4-2.44, p=0.007) (Figure) and (MD: 4.21, CI: 2.33-6.09, p<0.0001) respectively. Conclusion: The results of our meta-analysis suggest that TAVI procedures using CV and EV provide clinically similar valvular performance with possibly clinically insignificant subtle differences in mean and peak trans-aortic pressure gradients in patients with severe aortic stenosis. Further randomized studies are needed for long term echocardiographic outcomes to evaluate valvular performance.
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