Transcatheter Aortic Valve Replacement in Mixed Aortic Valve Disease: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND Utilization of transcatheter aortic valve replacement (TAVR) has expanded from high-risk patients to intermediate and select low-risk candidates with severe aortic stenosis (AS). TAVR is currently not indicated for patients with aortic insufficiency, and its outcomes in mixed aortic valve disease (MAVD) are unclear. METHODS A systematic search of PubMed, Medline, CINHAL and Cochrane databases was performed to identify studies comparing TAVR outcomes in patients with AS vs. MAVD. Primary outcomes included 30-day and late all-cause mortality, and paravalvular regurgitation (PVR). Secondary outcomes were major bleeding, vascular complications, device implantation success, permanent pacemaker and stroke. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated using Der Simonian-Laird random-effects model. RESULTS Six observational studies with 58,879 patients were included in the analysis. There was no significant difference in 30-day all-cause mortality (OR 1.03 [95% CI 0.92-1.15]; p = 0.63), however, MAVD group had higher odds of moderate to severe PVR (1.81 [1.41-2.31]; p<0.01). MAVD patients had lower odds of device implantation success (0.60 [0.40-0.91]; p = 0.02) while other secondary outcomes were similar in the two groups. CONCLUSIONS TAVR in MAVD is associated with increased odds of paravalvular regurgitation and lower odds of device implantation success when compared to severe aortic stenosis.