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Transcatheter Aortic Valve Implantation With or Without Pre-implantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta-analysis

Bagur, Rodrigo; Shing Kwok, Chun; Nombela-Franco, Luis; Ludman, Peter; de Belder, Mark; Sponga, Sandro; Gunning, Mark; Nolan, James; Kiaii, Bob; Diamantouros, Pantelis; Chu, Michael; Teefy, Patrick; Mamas, Mamas

Transcatheter Aortic Valve Implantation With or Without Pre-implantation Balloon Aortic Valvuloplasty: A Systematic Review and Meta-analysis Thumbnail


Authors

Rodrigo Bagur

Chun Shing Kwok

Luis Nombela-Franco

Peter Ludman

Mark de Belder

Sandro Sponga

Mark Gunning

Bob Kiaii

Pantelis Diamantouros

Michael Chu

Patrick Teefy



Abstract

Objectives: Pre-implantation balloon-aortic valvuloplasty (BAV) is considered routine procedure during transcatheter aortic valve implantation (TAVI) to facilitate prosthesis implantation and expansion; however, it has been speculated that fewer embolic events and/or hemodynamic instability may occur if TAVI is performed without pre-implantation BAV. Hence, the aim of the study was to systematically review the clinical outcomes associated with TAVI undertaken without pre-implantation BAV. Methods and Results: We conducted a search of MEDLINE and EMBASE to identify studies that evaluated patients who underwent TAVI with/without pre-implantation BAV for predilation. Pooled analysis and random effects meta-analyses were used to estimate the rate and risk of adverse outcomes. Sixteen studies involving 1395 patients (674/721 with/without preimplantation BAV) fulfilled the inclusion criteria. Crude device success was achieved in 94% (1311/1395) and 30-day all-cause mortality occurred in 6% (72/1282) of patients. Meta-analyses evaluating outcomes between pre-implantation BAV versus without BAV strategies showed no statistically significant differences in terms of mortality (risk ratio [RR]: 0.61, 95% confidence interval [CI]: 0.32-1.14, P=0.12), safety composite endpoint (RR: 0.85, 95%CI: 0.62-1.18, P=0.34), moderate-to-severe paravalvular leaks (RR: 0.68, 95%CI: 0.23-1.99, P=0.48), need for postdilation (RR: 0.86, 95%CI: 0.66-1.13, P=0.58), stroke and/or transient ischemic attack (RR: 0.72, 95%CI: 0.30-1.71, P=0.45), and permanent pacemaker implantation (RR: 0.80, 95%CI: 0.49-1.30, P=0.37). Conclusion: Our analysis suggests that TAVI procedures with or without pre-implantation BAV were associated with similar outcomes in a number of clinically relevant endpoints. Further Disclaimer: The manuscript and its contents are confidential, intended for journal review purposes only, and not to be further disclosed. JAHA/2015/003191-R1 3 studies including a significant number of patients are needed to ascertain the impact of TAVI without pre-implantation BAV as a standard practice.

Journal Article Type Article
Acceptance Date Apr 20, 2016
Publication Date Apr 1, 2016
Publicly Available Date Mar 29, 2024
Journal Journal of the American Heart Association
Print ISSN 2047-9980
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 67
Issue 13
Pages 411-411
DOI https://doi.org/10.1016/S0735-1097%2816%2930412-0
Keywords aortic stenosis, TAVI, TAVR, balloon-expandable, self-expandable, balloonvalvuloplasty
Publisher URL http://dx.doi.org/10.1016/S0735-1097(16)30412-0

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