Meta-Analysis and Meta-Regression of Transcatheter Aortic Valve Implantation for Pure Native Aortic Regurgitation

Abstract

To assess outcomes of transcatheter aortic valve implantation (TAVI) for pure native aortic regurgitation (AR) and to evaluate whether 30-day all-cause mortality is modulated by patient characteristics, we performed a meta-analysis and meta-regression of currently available studies. Studies enrolling ≥20 patients undergoing TAVI for AR were considered for inclusion. Study-specific estimates (incidence rates of outcomes) were combined using one-group meta-analysis in a random-effects model. Subgroup meta-analysis of studies exclusively using early-generation devices (EGD) and new-generation devices (NGD) and stepwise random-effects multivariate meta-regression were also performed. The search identified 11 eligible studies including a total of 911 patients undergoing TAVI for AR. Pooled analysis demonstrated an incidence of device success of 80.4% (NGD 90.2%, EGD 67.2%; p < 0.001), moderate or higher paravalvular aortic regurgitation (PAR) of 7.4% (NGD 3.4%, EGD 17.3%; p < 0.001), 30-day all-cause mortality of 9.5% (NGD 6.1%, EGD 14.7%; p < 0.001), mid-term (4 mo - 1 yr) all-cause mortality of 18.8% (NGD 11.8%, EGD 32.2%; p < 0.001), life-threatening/major bleeding complications (BC) 5.7% (NGD 3.5%, EGD 12.4%; p = 0.015), and major vascular complications (MVC) of 3.9% (NGD 3.0%, EGD 6.2%; p = 0.041). All coefficients in the multivariate meta-regression adjusting simultaneously for the proportion of diabetes mellitus, chronic obstructive pulmonary disease, peripheral arterial disease, concomitant moderate or higher mitral regurgitation, and mean left ventricular ejection fraction (with significant coefficients in the univariate meta-regression) were not statistically significant. Thirty (30)-day all-cause mortality after TAVI for AR was high (9.5%) with a high incidence of moderate or higher PAR (7.4%). Compared with EGD, NGD was associated with significantly higher device success rates and significantly lower rates of second-valve deployment, moderate or higher PAR, 30-day/mid-term all-cause mortality, serious BC, and MVC.