Network meta-analysis of new-generation valves for transcatheter aortic valve implantation

To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).