Structural valve deterioration after transcatheter aortic valve implantation

• Published in: Heart (British Cardiac Society) Vol. 103; no. 23; pp. 1899 - 1905
• Main Authors: Foroutan, Farid, Guyatt, Gordon H, Otto, Catherine M, Siemieniuk, Reed A, Schandelmaier, Stefan, Agoritsas, Thomas, Vandvik, Per O, Bhagra, Sai, Bagur, Rodrigo
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.12.2017
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bias; Cardiovascular disease; Chronic obstructive pulmonary disease; Coronary vessels; Heart; Heart Valve Prosthesis; Humans; Medical prognosis; Meta-analysis; Patients; Prostheses; Prosthesis Design; Prosthesis Failure; Risk Assessment; Risk Factors; Software; Statistical analysis; Studies; Survival analysis; Systematic review; Thrombosis; Time Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Treatment Outcome; meta-analysis; aortic stenosis; systematic review; transcatheter valve interventions
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2017-311329

BackgroundTranscatheter aortic valve implantation (TAVI), widely used to treat high-risk patients with severe symptomatic aortic stenosis, has recently been extended to younger patients at lower operative risk in whom long-term durability of TAVI devices is an important concern. Therefore, we conducted a systematic review and meta-analysis of observational studies addressing the frequency of structural valve deterioration (SVD) after TAVI.MethodsWe searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We included observational studies following patients with TAVI for at least 2 years. Independently and in duplicate, we evaluated study eligibility, extracted data, and assessed risk of bias for SVD post-TAVI. Our review used the GRADE system to assess quality of evidence. We pooled incidence rates using a random effects model.ResultsThirteen studies including 8914 patients, with a median follow-up between 1.6 and 5 years, reported an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to 73.44 per 100 patient years). Of those who developed SVD, 12% underwent valve re-intervention. Confidence in the evidence was moderate due to inconsistency among studies.ConclusionStructural valve deterioration is probably an infrequent event within the first 5 years after TAVI. Ascertaining the impact of SVD and the need for valve-related re-interventions to inform recommendations for patients with a longer life-expectancy will require studies including a large number of patients with longer follow-up (>10 years).