Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation: A network meta-analysis
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Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation : A network meta-analysis. / D'Ascenzo, Fabrizio; Bruno, Francesco; Baldetti, Luca; De Filippo, Ovidio; Marengo, Giorgio; Breviario, Susanna; Melillo, Francesco; Thyregod, Hans Gustav Horsted; Thiele, Holger; Sondergaard, Lars; Popma, Jeffrey J.; Kodali, Susheel; Franchin, Luca; Annaratone, Margherita; Marruncheddu, Laura; Gallone, Guglielmo; Crimi, Gabriele; La Torre, Michele; Rinaldi, Mauro; Omede, Pierluigi; Conrotto, Federico; Salizzoni, Stefano; De Ferrari, Gaetano Maria.
I: International Journal of Cardiology, Bind 337, 2021, s. 90-98.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Aortic valve replacement vs. balloon-expandable and self-expandable transcatheter implantation
T2 - A network meta-analysis
AU - D'Ascenzo, Fabrizio
AU - Bruno, Francesco
AU - Baldetti, Luca
AU - De Filippo, Ovidio
AU - Marengo, Giorgio
AU - Breviario, Susanna
AU - Melillo, Francesco
AU - Thyregod, Hans Gustav Horsted
AU - Thiele, Holger
AU - Sondergaard, Lars
AU - Popma, Jeffrey J.
AU - Kodali, Susheel
AU - Franchin, Luca
AU - Annaratone, Margherita
AU - Marruncheddu, Laura
AU - Gallone, Guglielmo
AU - Crimi, Gabriele
AU - La Torre, Michele
AU - Rinaldi, Mauro
AU - Omede, Pierluigi
AU - Conrotto, Federico
AU - Salizzoni, Stefano
AU - De Ferrari, Gaetano Maria
PY - 2021
Y1 - 2021
N2 - Introduction: Recently, observational data have raised concerns about safety of selfexpandable (SE) compared to balloon-expandable (BE) valves in TAVI, although potentially limited by patient selection bias. Methods. All Randomized Controlled Trials (RCTs) comparing BE vs. SE TAVI or/and vs. aortic valve replacement (AVR) were included and compared through Network Meta Analysis (NMA). All-cause and cardiovascular (CV) mortality were the primary endpoints, stroke, rates of permanent pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and reintervention were the secondary endpoints. Results We obtained data from 11 RCTs, encompassing 9752 patients. After one and two years, no significant differences for allcause and CV mortality were observed. Compared to surgical bioprostheses, both BE and SE TAVI reduced the risk of acute kidney injury (OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95% 0.32-0.60), new-onset atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and OR 0.21; CI 95% 0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65 and OR 0.47; CI 95% 0.25-0.89). The BE prostheses reduced the risk of moderate/severe PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both at 30-day (OR 0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95% 0.30-0.55) as compared to SE TAVI. Conclusions A TAVI strategy, independently from BE or SE prostheses, offers a midterm survival comparable to AVR. The BE prostheses are associated with a reduction of PPI and PVL compared to SE prostheses without any differences in all-cause and CV mortality during two years of follow up. PROSPERO ID CRD42020182407. (c) 2021 Elsevier B.V. All rights reserved.
AB - Introduction: Recently, observational data have raised concerns about safety of selfexpandable (SE) compared to balloon-expandable (BE) valves in TAVI, although potentially limited by patient selection bias. Methods. All Randomized Controlled Trials (RCTs) comparing BE vs. SE TAVI or/and vs. aortic valve replacement (AVR) were included and compared through Network Meta Analysis (NMA). All-cause and cardiovascular (CV) mortality were the primary endpoints, stroke, rates of permanent pacemaker implantation (PPI), moderate/severe paravalvular leak (PVL) and reintervention were the secondary endpoints. Results We obtained data from 11 RCTs, encompassing 9752 patients. After one and two years, no significant differences for allcause and CV mortality were observed. Compared to surgical bioprostheses, both BE and SE TAVI reduced the risk of acute kidney injury (OR 0.42; CI 95% 0.30-0.60 and OR 0.44; CI 95% 0.32-0.60), new-onset atrial fibrillation (OR 0.24; CI 95% 0.14-0.42 and OR 0.21; CI 95% 0.13-0.34) and major bleedings (OR 0.32; CI 95% 0.16-0.65 and OR 0.47; CI 95% 0.25-0.89). The BE prostheses reduced the risk of moderate/severe PVL at 30-day (OR 0.31; CI 95% 0.17-0.55) and of PPI both at 30-day (OR 0.51; CI 95% 0.33-0.79) and 1 year (OR 0.40; CI 95% 0.30-0.55) as compared to SE TAVI. Conclusions A TAVI strategy, independently from BE or SE prostheses, offers a midterm survival comparable to AVR. The BE prostheses are associated with a reduction of PPI and PVL compared to SE prostheses without any differences in all-cause and CV mortality during two years of follow up. PROSPERO ID CRD42020182407. (c) 2021 Elsevier B.V. All rights reserved.
KW - Aortic stenosis
KW - Transcatheter aortic valve implantation
KW - Surgical aortic valve implantation
KW - Self-expandable valves
KW - Balloon-expandable valves
KW - 2-YEAR OUTCOMES
KW - IMPACT
KW - PREDICTORS
KW - STENOSIS
U2 - 10.1016/j.ijcard.2021.04.068
DO - 10.1016/j.ijcard.2021.04.068
M3 - Journal article
C2 - 33974961
VL - 337
SP - 90
EP - 98
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -
ID: 302197541