Comparative meta-analysis of balloon-expandable and self-expandable valves for transcatheter aortic valve replacement

BackgroundBalloon-expandable valves (BEVs) and self-expandable valves (SEVs) are two major types of valves utilized for transcatheter aortic valve replacement (TAVR). We conducted a meta-analysis of available studies to compare the safety and efficacy of these two valve types.MethodsMedline search was conducted using standard search terms to determine eligible studies. Primary outcomes of the meta-analysis included death and stroke at 30 days and 1 year. Pooled estimates of procedural outcomes were also compared between the valve types. Analysis was performed for entire cohort and separately for patients undergoing transfemoral TAVR (TF-TAVR).ResultsAnalysis of entire cohort revealed similar 30-day mortality in the SEV and BEV cohorts. There was no significant difference in the incidence of stroke at 30 days between the two study groups. Both pooled comparisons demonstrated a significant heterogeneity with I2 > 50%, necessitating the use of random effect modeling. We observed a significantly higher incidence of new pacemaker implantation, aortic regurgitation ≥ 2 + at 30 days, valve embolization, and need for > 1 valve following SEV implantation compared with BEV implantation. Analysis of TF-TAVR cohort showed higher 30 day [IRR (95% CI): 1.34 (1.19–1.52)] but a similar 1-year mortality [IRR (95% CI): 1.07 (0.96–1.19)] for SEV compared to BEV implantation.ConclusionCompared to BEV implantation, SEV implantation was associated with a similar risk of mortality and stroke at 30-day and 1-year follow-up duration. Analysis of the TF-TAVR cohort revealed a significantly higher mortality at 30 days among patients undergoing SEV implantation, compared with BEV implantation. In addition, there was a significantly higher incidence of other adverse events noted above, following SEV implantation, compared with BEV implantation.