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Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta-analysis

Tomo Ando1,2, Alexandros Briasoulis3, Tesfaye Telila1

  • 1Division of Cardiology, Wayne State University, Harper Hospital, Detroit, Michigan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 1, 2017
PubMed
Abstract

Insights

Mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is linked to increased mortality. This meta-analysis confirms that even mild PVR significantly impacts patient survival outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biostatistics

Background:

  • Mild paravalvular regurgitation (PVR) is a common complication following transcatheter aortic valve implantation (TAVI).
  • The clinical significance of mild PVR remains debated, despite advancements in prosthetic valve technology.
  • Existing data on mild PVR's impact on mortality are inconsistent, necessitating further investigation.

Purpose of the Study:

  • To quantitatively assess the association between mild PVR after TAVI and patient mortality.
  • To synthesize evidence from multiple studies to determine the clinical impact of mild PVR.
  • To provide a clearer understanding of the prognostic implications of mild PVR post-TAVI.

Main Methods:

  • A systematic literature search was performed using PubMed and Embase databases.
  • Meta-analysis included 25 studies with 21,018 patients, focusing on hazard ratios for all-cause and cardiac mortality.
  • Random-effects models were employed to pool data and assess heterogeneity and publication bias.

Main Results:

  • Mild PVR was associated with a significant increase in all-cause mortality (HR 1.26, 95% CI 1.11-1.43).
  • Cardiovascular mortality was also elevated in patients with mild PVR compared to those with none/trivial PVR (HR 1.28, 95% CI 1.05-1.57).
  • Significant heterogeneity was observed across studies for all-cause mortality, but not for cardiovascular mortality.

Conclusions:

  • Mild PVR following TAVI is a significant predictor of increased all-cause and cardiovascular mortality.
  • The findings underscore the importance of monitoring patients with mild PVR post-TAVI.
  • Further research is needed to determine if interventions for mild PVR can improve clinical outcomes.
Keywords:
aortic valve diseasemeta-analysistranscatheter valve implantation

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