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Wang B, Mei Z, Ge X, Li Y, Zhou Q, Meng X, An G. Comparison of outcomes of self-expanding versus balloon-expandable valves for transcatheter aortic valve replacement: a meta-analysis of randomized and propensity-matched studies. BMC Cardiovasc Disord 2023; 23:382. [PMID: 37525092 PMCID: PMC10388567 DOI: 10.1186/s12872-023-03397-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The postoperative outcomes of transcatheter aortic valve replacement (TAVR) with the new generation of self-expanding valves (SEV) and balloon-expandable valves (BEV) remain uncertain. METHODS We conducted a meta-analysis based on randomized controlled trials (RCTs) and propensity score-matched (PSM) studies to evaluate the performance of the new generation TAVR devices, with a focus on Edwards SAPIEN 3/Ultra BEV, Medtronic Evolut R/PRO SEV, and Boston ACURATE neo SEV. Our primary endpoints were mortality and complications at both 30 days and one year post-operation. RESULTS A total of 4 RCTs and 14 PSM studies were included. Our findings showed no significant difference between SEV and BEV regarding 30-day and 1-year mortality rates. ACURATE SEV required less permanent pacemaker implantation (PPI) at 30-day as compared to SAPIEN BEV, while Evolut SEV required a higher rate of PPI than SAPIEN BEV. The incidence of stroke, major or life-threatening bleeding (MLTB), major vascular complications (MVC), coronary artery obstruction (CAO) and acute kidney injury (AKI) did not differ significantly between the two groups. SEV had a larger effective orifice area (EOA) and lower mean transvalvular gradients (MPG) compared to BEV. However, there was an increased risk of paravalvular leakage (PVL) associated with SEV. CONCLUSIONS In terms of 30-day mortality, stroke, bleeding, MVC, AKI, CAO, and one-year mortality, there was comparability between the two valve types following TAVR. SEV was associated with better hemodynamic outcomes, except for a higher incidence of PVL. Compared to SAPIEN BEV, ACURATE SEV had a lower risk of PPI at 30 days, while Evolut SEV was associated with a higher risk of PPI. These findings underscore the importance of personalized valve selection.
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Affiliation(s)
- Baiqiang Wang
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Zeyuan Mei
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Ge
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Yunyi Li
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Quan Zhou
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Xiao Meng
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Guipeng An
- National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China.
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Poschner T, Werner P, Kocher A, Laufer G, Musumeci F, Andreas M, Russo M. The JenaValve pericardial transcatheter aortic valve replacement system to treat aortic valve disease. Future Cardiol 2021; 18:101-113. [PMID: 34647465 DOI: 10.2217/fca-2021-0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Transcatheter aortic valve replacement is a valuable alternative technique to surgery and the spectrum of therapy continues to evolve. The JenaValve Pericaridal transcatheter aortic valve replacement System allows prosthesis fixation in a native, noncalcified aortic annulus with a unique paper clip-like anchorage mechanism. The low rate of paravalvular leakage and permanent pacemaker implantation emphasizes the further widespread use of the JenaValve - despite the limited data available. In May 2021, a CE mark for the transfemoral implantation in both aortic regurgitation and aortic stenosis was granted. However, no data have been published so far. The ongoing ALIGN trials are expected to provide the pending long-term data.
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Affiliation(s)
- Thomas Poschner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Paul Werner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Francesco Musumeci
- Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria.,Department of Cardiac Surgery & Heart Transplantation, San Camillo Forlanini Hospital of Rome, Rome, Italy
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Byrne L, Wheen P, O'Connor S. Emergency TAVI in cardiogenic shock and cardiorenal syndrome secondary to severe bicuspid aortic stenosis. BMJ Case Rep 2021; 14:14/4/e239003. [PMID: 33863765 PMCID: PMC8055140 DOI: 10.1136/bcr-2020-239003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Three-dimensional transoesophageal echocardiography guidance was used to assist annulus sizing. An emergency transcatheter aortic valve replacement (eTAVI) was carried out 5 days into admission with a 34 mm Core Valve Evolut Pro valve with a no contrast technique. The patient's blood pressure and urine output improved and no procedural complications were encountered. He was discharged after 21 days and has remained well subsequently. This case highlights the utility of eTAVI and demonstrates the feasibility of a no contrast approach.
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Affiliation(s)
- Luke Byrne
- Cardiology, St James Hospital, Dublin, Ireland
| | - Peter Wheen
- Cardiology, St James Hospital, Dublin, Ireland
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Gozdek M, Zieliński K, Pasierski M, Matteucci M, Fina D, Jiritano F, Meani P, Raffa GM, Malvindi PG, Pilato M, Paparella D, Słomka A, Kubica J, Jagielak D, Lorusso R, Suwalski P, Kowalewski M. Transcatheter Aortic Valve Replacement with Self-Expandable ACURATE neo as Compared to Balloon-Expandable SAPIEN 3 in Patients with Severe Aortic Stenosis: Meta-Analysis of Randomized and Propensity-Matched Studies. J Clin Med 2020; 9:E397. [PMID: 32024168 PMCID: PMC7074302 DOI: 10.3390/jcm9020397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Frequent occurrence of paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) was the main concern with earlier-generation devices. Current meta-analysis compared outcomes of TAVR with next-generation devices: ACURATE neo and SAPIEN 3. In random-effects meta-analysis, the pooled incidence rates of procedural, clinical and functional outcomes according to VARC-2 definitions were assessed. One randomized controlled trial and five observational studies including 2818 patients (ACURATE neo n = 1256 vs. SAPIEN 3 n = 1562) met inclusion criteria. ACURATE neo was associated with a 3.7-fold increase of moderate-to-severe PVL (RR (risk ratio): 3.70 (2.04-6.70); P < 0.0001), which was indirectly related to higher observed 30-day mortality with ACURATE valve (RR: 1.77 (1.03-3.04); P = 0.04). Major vascular complications, acute kidney injury, periprocedural myocardial infarction, stroke and serious bleeding events were similar between devices. ACURATE neo demonstrated lower transvalvular pressure gradients both at discharge (P < 0.00001) and at 30 days (P < 0.00001), along with lower risk of patient-prosthesis mismatch (RR: 0.29 (0.10-0.87); P = 0.03) and pacemaker implantation (RR: 0.64 (0.50-0.81); P = 0.0002), but no differences were observed regarding composite endpoints early safety and device success. In conclusion, ACURATE neo, as compared with SAPIEN 3, was associated with higher rates of moderate-to-severe PVL, which were indirectly linked with increased observed 30-day all-cause mortality.
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Affiliation(s)
- Mirosław Gozdek
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum, 85067 Bydgoszcz, Poland; (M.G.); (J.K.)
- Thoracic Research Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Innovative Medical Forum, 85067 Bydgoszcz, Poland; (K.Z.); (M.P.)
| | - Kamil Zieliński
- Thoracic Research Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Innovative Medical Forum, 85067 Bydgoszcz, Poland; (K.Z.); (M.P.)
- Department of Cardiology, Warsaw Medical University, 02091 Warsaw, Poland
| | - Michał Pasierski
- Thoracic Research Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Innovative Medical Forum, 85067 Bydgoszcz, Poland; (K.Z.); (M.P.)
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02607 Warsa, Poland; (P.S.)
| | - Matteo Matteucci
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, 21100 Varese, Italy
| | - Dario Fina
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
- Department of Cardiology, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy
| | - Federica Jiritano
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
- Department of Cardiac Surgery, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Paolo Meani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
- Department of Intensive Care Unit, Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), 90127 Palermo, Italy; (G.M.R.); (M.P.)
| | | | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), 90127 Palermo, Italy; (G.M.R.); (M.P.)
| | - Domenico Paparella
- GVM Care & Research, Department of Cardiovascular Surgery, Santa Maria Hospital, 70124 Bari, Italy;
- Department of Emergency and Organ Transplant, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Artur Słomka
- Thoracic Research Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Innovative Medical Forum, 85067 Bydgoszcz, Poland; (K.Z.); (M.P.)
- Chair and Department of Pathophysiology, Nicolaus Copernicus University, Collegium Medicum, 85067 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Collegium Medicum, 85067 Bydgoszcz, Poland; (M.G.); (J.K.)
| | - Dariusz Jagielak
- Department of Cardiac Surgery, Gdańsk Medical University, 80210 Gdańsk, Poland;
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02607 Warsa, Poland; (P.S.)
| | - Mariusz Kowalewski
- Thoracic Research Centre, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Innovative Medical Forum, 85067 Bydgoszcz, Poland; (K.Z.); (M.P.)
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02607 Warsa, Poland; (P.S.)
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (M.M.); (D.F.); (F.J.); (P.M.); (R.L.)
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He C, Xiao L, Liu J. Safety and efficacy of self-expandable Evolut R vs. balloon-expandable Sapien 3 valves for transcatheter aortic valve implantation: A systematic review and meta-analysis. Exp Ther Med 2019; 18:3893-3904. [PMID: 31602250 PMCID: PMC6777306 DOI: 10.3892/etm.2019.8000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to systematically search literature and conduct a meta-analysis comparing the clinical efficacy and safety of Evolut R and Sapien 3 valves for transcatheter aortic valve implantation (TAVI). The PubMed, Biomed Central, Scopus, Cochrane library and Google scholar databases were searched for articles published up to June, 2019. A total of 5 studies were included. In total, 795 patients underwent TAVI with Evolut R, while 665 patients received the Sapien 3 valve in the included studies. Overall device success with Evolut R was 95.7% and with Sapien 3 was 94.2%. Pooled data indicated no significant differences between the 2 valves (OR, 1.12; 95% CI, 0.66–1.89; P=0.68; I2=0%). No significant differences were observed in the incidence of none to mild paravalvular leakage between the 2 groups (OR, 1.71; 95% CI, 0.83–3.54; P=0.14; I2=0%). Both mean [random; mean difference (MD) = −3.96; 95% CI, −4.61 to −3.31; P<0.00001, I2=0%] and peak (random; MD = −6.85; 95% CI, −8.22 to −5.48; P<0.00001, I2=0%) aortic valve gradients were significantly lower with Evolut R. No significant differences were observed in the 30-day mortality (OR, 1.32; 95% CI, 0.45–3.87; P=0.62; I2=0%) or 30-day stroke outcomes (OR, 0.76; 95% CI, 0.32–1.81; P=0.54; I2=0%) between the 2 devices. On the whole, the findings of this study indicate that Evolut R and Sapien 3 valves may be comparable in terms of device success and short-term complications. The differences between the 2 devices for post-operative moderate to severe paravalvular leak and permanent pacemaker implantation remain unclear. There is thus a need for a large multi-center randomized controlled trial to provide stronger evidence on this subject.
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Affiliation(s)
- Chenglin He
- Department of Cardiovascular Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
| | - Lang Xiao
- Department of Haematology, Hanchuan Hospital of Traditional Chinese Medicine, Hanchuan, Hubei 431600, P.R. China
| | - Junli Liu
- Department of Critical Care Medicine, Hanchuan People's Hospital, Hanchuan, Hubei 431600, P.R. China
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