Is valve choice a significant determinant of paravalular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis
Selected in European Journal of Cardio-thoracic Surgery by Rylski
Katie E. O'Sullivan, Aideen Gough, Ricardo Segurado, Mitchel Barry, Declan Sugrue, John Hurley
Eur J Cardiothorac Surg 2014;45:826-833
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Paravalvular regurgitation (PVR) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with poor survival. The authors aimed to analyse the incidence and risk factors predisposing to PVR after implantation of Medtronic CoreValve (MCV) vs Edward Sapien (ES) prostheses.
- Meta-analysis on 5910 patients from 9 studies
- MCV was associated with a higher PVR rate compared with ES (16% vs. 4%, P=0.0002)
- Valve position, size and commissural calcification influenced PVR incidence
The authors clearly showed that valve choice is a significant determinant of PVR after TAVI. This is a very important finding, since according to PARTNER trial (3-year follow-up), PVR significantly increases mortality from 35% for mild to 61% for moderate-to-severe PVR. It is still unresolved complication of TAVI without any established endovascular treatment option. New generation of TAVI devices and better imaging might decrease the incidence of this serious complication.