Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta-analysis.

Abstract

To assess the impact of post transcatheter aortic valve implantation (TAVI) mild paravalvular regurgitation (PVR) on mortality. More than moderate PVR after TAVI has decreased with the advent of new-generation prosthetic valves. However, mild PVR remains common and its clinical impact has been inconsistent. We aimed to assess the impact of mild PVR through meta-analysis. A systematic literature search was conducted through PUBMED and EMBSE. Manuscripts that reported hazard ratio (HR) with 95% confidence interval (CI) for clinical outcome of interest (all-cause and cardiac mortality) has been included. Random-effects model was used for calculation of HR. A total of 25 articles including total of 21,018 patients were finally included for quantitative synthesis (meta-analysis). Our pooled analysis demonstrated higher all-cause mortality in patients with mild PVR compared to none/trivial PVR (HR 1.26, 95%CI 1.11-1.43, I2 =45%, p < 0.001) (follow up duration range 6 months to 5 years). Significant heterogeneity among studies was observed (p for heterogeneity = 0.005). Egger's test showed no evidence of publication bias. Cardiovascular mortality was increased in patients with mild PVR compared with none/trivial PVR (HR 1.28, 95%CI 1.05-1.57, I2 =8%, p = 0.02) (follow up duration range 1-3 years). Mild PVR was associated with increased all-cause and cardiovascular mortality after TAVI. Whether further interventions in mild PVR is of benefit, has yet to be determined.