Transcatheter Aortic Valve Replacement for the Treatment of Pure Native Aortic Valve Regurgitation: A Systematic Review

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• 作者：Anna Franzone ; MD^a ; Raffaele Piccolo ; MD^a ; George C.M. Siontis ; MD^a ; Jonas Lanz ; MD^a ; Stefan Stortecky ; MD^a ; Fabien Praz ; MD^a ; Eva Roost ; MD^b ; René ; Vollenbroich ; MD ; MPP^a ; Stephan Windecker ; MD^a ; Thomas Pilgrim ; MD^a ; ^{thomas.pilgrim@insel.ch" class="auth_mail" title="E-mail the corresponding author}
• 关键词：meta-analysis ; pure native aortic regurgitation ; systematic review ; transcatheter aortic valve replacement
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：28 November 2016
• 年：2016
• 卷：9
• 期：22
• 页码：2308-2317
• 全文大小：1661 K

文摘

This study sought to summarize available evidence on transcatheter aortic valve replacement (TAVR) for the treatment of native pure aortic regurgitation (AR).

Background

Surgical aortic valve replacement (SAVR) is the gold standard for the treatment of AR. However, case series of high-risk patients undergoing TAVR for native pure AR were reported.

Methods

We systematically searched Medline, Embase, and Scopus for reports of at least 5 patients with native pure AR undergoing TAVR. Patients’ and procedural characteristics were summarized. The primary outcome of interest was all-cause mortality. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42016038422).

Results

Thirteen reports including 237 patients were included in the analysis. Self-expandable prostheses were used in 79% of patients, whereas 21% of the patients were treated with a balloon-expandable valve. Device success ranged between 74% and 100%. Seventeen patients (7%) required the implantation of a second valve. Conversion to SAVR was reported in 6 (2.5%) cases. The rate of all-cause mortality at 30 days amounted to 7% (95% confidence interval [CI]: 3% to 13%; I² = 37%). Cerebrovascular events were rare (0%, 95% CI: 0% to 1%; I² = 0); major bleeding and vascular complications occurred in 2% (95% CI: 0% to 7%; I² = 41%), and 3% (95% CI: 1% to 7%; I² = 0%), respectively. Permanent pacemaker implantation was required in 11% of patients (95% CI: 5% to 19%; I² = 50%). The rate of moderate or severe post-procedural AR amounted to 9% (95% CI: 0% to 28%; I² = 90%).

Conclusions

Among selected patients with native pure AR deemed at high risk for SAVR, TAVR is technically feasible and associated with an acceptable risk of early mortality.