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

Hsiu-An Lee,Dong-Yi Chen,An-Hsun Chou,Yu-Ting Cheng,Pao-Hsien Chu,Victor Chien-Chia Wu,Kuang-Tso Lee,Shao-Wei Chen,Shang-Hung Chang,Hsin-Fu Lee,Corstiaan Den Uil

doi:10.1371/journal.pone.0233894

Hsiu-An Lee, Dong-Yi Chen + Show 9 more

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https://doi.org/10.1371/journal.pone.0233894

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Journal: PloS one	Publication Date: Jun 1, 2020
Citations: 16	License type: CC BY 4.0

Affiliation: Chang Gung Memorial Hospital

Abstract

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. 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. 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). 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.

Highlights

The use of bioprosthetic valves in surgical aortic valve replacement (AVR) has increased considerably during the last few decades [1], in middle-aged patients, largely driven by patients’ wish of avoiding lifelong anticoagulation
Balloon-expandable valve (BEV) was associated with significantly lower rates of postprocedural permanent pacemaker implantation (3.8% vs. 12%; P < 0.001)
self-expanding valve (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)

Summary

Introduction

The use of bioprosthetic valves in surgical aortic valve replacement (AVR) has increased considerably during the last few decades [1], in middle-aged patients, largely driven by patients’ wish of avoiding lifelong anticoagulation. Balloon-expandable valve (BEV) and self-expanding valve (SEV) are the two major types of transcatheter heart valves (THVs). These two THV types are different in valve height, implantation depth, relative position of the valve and the annulus, radial force, deployment mechanism, and valve geometry and may result in different outcomes and rates of complication, such as postprocedural transvalvular pressure gradient, conduction block, or paravalvular leak (PVL). 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.

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