心血管疾患と診断

Comparison of Various Transcatheter Aortic Valves for Aortic Stenosis a Network Meta-analysis of Randomized Controlled Trials

Abstract

Ankur Sethi1*, Emily Hiltner1, Monarch Shah2, Derek Schwabe-Warf1, Bruce Haik1, Abdul Hakeem1 and Mark Russo1

Objectives: Our aim was to compare available Transcatheter Aortic Valve Replacement (TAVR) valves using direct and indirect evidence from Randomized Controlled Trials (RCT).

Background: TAVR is now an established treatment for majority of patients with severe aortic stenosis. However, there is limited data comparing various valves.

Methods: We performed a systematic search of electronic databases for RCT comparing a TAVR valve to a valve or surgery. A Bayesian network meta-analysis was performed to compile evidence from both direct and indirect comparisons at 30 days and at one year.

Results: Twelve studies with 10,307 patients eligible for TAVR met the criteria and were included. Self-expanding Valve Core valve type (SEV_C) is associated with higher risk of pacemaker implantation and use of >1 valve, SEV Accurate type (SEV_A) is associated with higher risk of ≥ moderate Aortic Regurgitation (AR) and death, and Mechanically Expandable Valve (MEV) is associated with lower risk of ≥ moderate AR but higher risk of pacemaker at 30 days, SEV_C and MEV were associated with higher pacemaker rates compared balloon expandable valve (BEV) at 1 year. There is no difference among the valves in stroke at 30 days and 1 year.

Conclusions: At 30 days, BEV was superior on one or more outcomes of mortality, pacemaker implantation, >1 valve implantation and ≥ moderate AR compared to other valves except the higher rate ≥ moderate AR compared to MEV. At one year, BEV was associated with lower odds of pacemaker implantation compared to SEV_C and MEV but not different on other end points.