Mortality and major adverse cardiovascular events after transcatheter aortic valve replacement using Edwards valve...

In patients with severe aortic stenosis who are at high risk for surgery, transcatheter aortic valve replacement (TAVR) has emerged as an alternative procedure using EV or CV. The objective of this meta-analysis is to compare 1-year mortality and major adverse cardiovascular and cerebrovascular events (MACCE) between Edwards valve (EV) and Medtronic CoreValve (CV).

PubMed and the Cochrane Center Register of Controlled Trials were searched through December 2014. Twenty seven studies (n=12,249) comparing TAVR procedure that used EV (n=5745) and CV (n=6504) were included. End points were procedural success rates, post-procedural mortality, myocardial infarction (MI), stroke, major bleeding, major vascular complications, incidence of new permanent pacemaker (PPM) placement and new left bundle branch block (LBBB). The odds ratio (OR) with 95% confidence interval (CI) was computed and p<0.05 was considered for significance.

There were no significant differences between EV and CV for post-procedural in-hospital, 30-day and 1-year all-cause mortality rates (p=0.53, 0.33 and 0.94 respectively), cardiovascular mortality (p=0.61), stroke (p=0.54), major bleeding (p=0.25) and major vascular complications (p=0.27). MI was significantly lower with EV compared to CV (OR: 0.56, CI: 0.35-0.89, p=0.01). Placement of new PPM and new onset LBBB were significantly higher in CV compared to EV (OR: 3.35, CI: 2.96-3.79, p<0.00001 and OR: 6.55, CI: 4.76-9.03, p<0.00001 respectively).

The results of our meta-analysis suggest that TAVR procedure using CV may be associated with a higher incidence of MI, new PPM placement, and new onset LBBB compared to EV. However, the type of valve placed does not affect mortality.