Transcatheter Aortic Valve Replacement in Patients with Pure Native Aortic Valve Regurgitation: A Systematic Review and Meta-analysis.

OBJECTIVES: This systematic review and meta-analysis sought to summarize the available evidence on the use of TAVR in patients with Native Aortic Valve Regurgitation (NAVR) and compare outcomes between first and second generation valves.

BACKGROUND: Owing to the improvements in transcatheter heart valve design and procedural success, TAVR has become increasingly performed in broader aortic valve pathologies.

METHOD: We searched Medline, Embase, Cochrane and Scopus databases from 2007 to 2018 and performed a systematic review on reports with at least 10 patients with aortic valve regurgitation undergoing TAVR procedure. The main outcome of interest was all-cause mortality at 30 days.

RESULTS: A total of 638 patients across 12 studies were included. Mean age ranged from 68 to 84. Society of Thoracic Surgeons score ranged from 5.4 to 13.1% and Logistic Euroscore ranged from 18.2 to 33%. The incidence rate of all-cause mortality at 30 days was found to be 11% (95% CI 7%-16%; I2 = 20.86%). All-cause mortality at 30 days for first generation valves had an incidence rate of 15% (95% CI 10%-20%; I2 = 10%) compared to 7% (95% CI 3%-13%; I2 = 37%) in second generation valves with subgroup interaction analysis p= 0.059. Device success incidence rate in second generation valves was 92% (95% CI 83%-99%; I2 = 67%) vs. 68% (95% CI 59%-77%; I2 = 53%) in first generation valves with p= 0.001.

CONCLUSION: TAVR appears to be a feasible treatment choice for NAVR patients at high risk for surgical valve replacement. Second generation valves show promising results in terms of short term outcomes.