Comparison of outcomes in new-generation versus early-generation heart valve in transcatheter aortic valve implantation: A systematic review and meta-analysis.

BACKGROUND: New-generation (NG) valves for transcatheter aortic valve implantation (TAVI) has recently been widely used in real-world practice, yet its comparative outcomes with early-generation (EG) valves remain under-explored.

METHODS: An electronic literature search using PUBMED and EMBASE was conducted from inception to April 2017 for matched-cohort studies. Articles that compared the outcomes of NG vs. EG valves post TAVI with at least one of the following clinical outcome reported were included: all-cause mortality, major or life-threatening bleeding, major vascular complications (MVC), significant (more than moderate) paravalvular regurgitation (PVR), cerebrovascular events, significant (stage 2 or 3) acute kidney injury (AKI) and new permanent pacemaker implantation (PPI) that occurred either in-hospital or within 30-days.

RESULTS: A total of 6 observational matched-cohort studies with 585 and 647 patients included in NG and EG valves, respectively, were included. EG valves were associated with a lower incidence of major or life-threatening bleeding (5.7% vs. 15.7%, p<0.00001), significant paravalvular regurgitation (5.3% vs. 14.4%, p=0.001), and significant AKI (4.4% vs. 7.5, p=0.03). All-cause mortality (3.5% vs. 5.0, p=0.43), cerebrovascular events (3.4% vs. 2.3%, p=0.34) and new PPI (11.0% vs. 14.6%, p=0.52) were similar between the two groups. NG demonstrated lower tendency of MVC (2.5% vs. 7.2, p=0.09) compared to EG valves.

CONCLUSIONS: NG demonstrated lower rates of significant AKI, significant PVR and major or life-threatening bleeding while all-cause mortality, new PPI, and cerebrovascular events remained similar compared to EG valves.