Outcomes of Transcatheter Aortic Valve Implantation Comparing Medtronic's Evolut PRO and Evolut R: A Systematic Review and Meta-Analysis of Observational Studies

BACKGROUND

Transcatheter aortic valve implantation (TAVI) has become a broadly acceptable alternative to AV surgery in patients with aortic stenosis (AS). New valve designs are becoming available to address the shortcomings of their predecessors and improve clinical outcomes.

METHODS

A systematic review and meta-analysis was carried out to compare Medtronic's Evolut PRO, a new valve, with the previous Evolut R design. Procedural, functional and clinical endpoints according to the VARC-2 criteria were assessed.

RESULTS

Eleven observational studies involving N = 12,363 patients were included. Evolut PRO patients differed regarding age (p < 0.001), sex (p < 0.001) and STS-PROM estimated risk. There was no difference between the two devices in terms of TAVI-related early complications and clinical endpoints. A 35% reduction of the risk of moderate-to-severe paravalvular leak (PVL) favoring the Evolut PRO was observed (RR 0.66, 95%CI, [0.52, 0.86] p = 0.002; I2 = 0%). Similarly, Evolut PRO-treated patients demonstrated a reduction of over 35% in the risk of serious bleeding as compared with the Evolut R (RR 0.63, 95%CI, [0.41, 0.96]; p = 0.03; I2 = 39%), without differences in major vascular complications.

CONCLUSIONS

The evidence shows good short-term outcomes of both the Evolut PRO and Evolut R prostheses, with no differences in clinical and procedural endpoints. The Evolut PRO was associated with a lower rate of moderate-to-severe PVL and major bleeding.

Age dependence of plasma endothelin levels in glaucoma patients

The aim of the study was to investigate the endothelin-1 (ET-1) plasma level and its age dependence in patients with normal tension glaucoma (NTG), high tension glaucoma (HTG), and healthy controls. In blood samples from 35 NTG patients, 34 HTG patients, and 36 controls, ET-1 plasma levels were determined by enzyme-linked immunosorbent assay (ELISA). After adjustment for age and gender, the mean ET-1 levels were found to be similar in all three study groups. The age dependency however was highest in NTGs and significantly different from that of the controls. For the HTGs, this dependence was weaker and not significantly different from that of the controls. Our findings suggest that age had a significantly greater influence on ET plasma level in the NTG patients than in the HTG patients and controls. This supports previous reports indicating that ET plays a role in the pathogenesis of glaucoma, and in particular normal NTG.

AB0021 VARIABILITY OF THE RS333 IN LUPUS ERYTHEMATOSUS PATIENTS FROM THE POLISH POPULATION

Background:

There are several subtypes ofLupus Erythematosus(LE), which may be limited to the skin (eg.Discoid Lupus Erythematosus, DLE) or involve multiple organ dysfunctions (Systemic Lupus Erythematosus, SLE). LE is an autoimmune disease that is influenced by genetic and environmental factors. Despite some genetic changes between DLE and SLE were previously shown, the complete genetic background of DLE is still unresolved [1]. Functional C-C chemokine receptor 5 (CCR5) receptor can be associated with the inflammation in LE patients. Importantly, the 32 base pairs (bp) deletion inCCR5gene (rs333) leads to a nonfunctional receptor. Previous studies have shown that this mutation may have a protective effect on the development and progression of SLE [2, 3]. Thus it was important to investigate whether 32 bp deletion in rs333 is also associated with DLE development.

Objectives:

The aim of this study was to investigate the variability of theCCR5gene, within a polymorphiclocusrs333 in SLE and DLE patients from the Polish population.

Methods:

120 LE patients (77 SLE patients and 43 DLE patients) and 100 healthy persons were recruited to the study from the Polish population. DNA was isolated from blood or buccal swabs. rs333 was genotyped by using polymerase chain reaction (PCR). Statistical significance of the differences between patient and control groups in both allele and genotype frequencies were calculated using Chi-Squared test with Yates correction or two tailed Fisher’s exact test.

Results:

Deletion allele of the rs333 was significantly less frequent among DLE patients than healthy persons (p = 0.0171). Also the heterozygotes occur significantly less frequent within DLE patients group than in healthy individuals (p = 0.0375). Moreover, homozygotes without deletion in rs333 were found significantly more frequent in persons diagnosed with DLE than in healthy volunteers (p = 0.0214). In contrast, the differences in allele or genotype frequencies between SLE patients and healthy controls were not statistically significant (p > 0.05). Moreover, the rs333 variability was not associated with clinical symptoms of LE patients (p > 0.05).

Conclusion:

Summarizing, the results obtained in this study suggest that the 32 bp deletion within rs333 could be a protective factor, that reduce the risk for DLE but not SLE development in the Polish population. However, due to the low statistical power of the obtained results, further studies on larger groups of patients and controls are needed to acquire more reliable data.

References:

[1]Skonieczna K, Czajkowski R, Kaszewski S, Gawrych M, Jakubowska A, Grzybowski T. (2017) Genetic similarities and differences between discoid and systemic lupus erythematosus patients within the Polish population. Postepy Dermatol Alergol. 34: 228-232.

[2]Schauren JS, Marasca JA, Velt TD, Monticielo OA, Xavier RM, Brenol JCT et al (2013) CCR5 delta32 in systemic lupus erythematosus: implications for disease susceptibility and outcome in a Brazilian population. Lupus 22:802–809.

[3]Martens, H.A., Kallenberg, C.G. & Bijl, M. (2009) Role of CCR5 Delta32 bp deletion in RA and SLE. Autoimmunity, 42, 260.

Acknowledgments:

KS was supported by the “Excellence Initiative - Research University” programme as a member of the team “Bioinformatics in medical & population genomics”.

Disclosure of Interests:

Katarzyna Skonieczna Grant/research support from: KS was supported by the “Excellence Initiative - Research University” programme as a member of the team “Bioinformatics in medical & population genomics”., Dominika Mlicka: None declared, Anna Woźniacka: None declared, Rafał Czajkowski: None declared, Ewa Robak: None declared, Mariusz Gawrych: None declared, Anna Duleba: None declared, Tomasz Grzybowski: None declared