A Systematic Review and Meta-Analysis of the Incidence of Paravalvular Leak Incidence Post Procedure, Six Months and One-Year Following TAVI.
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Date
2013-07
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Abstract
Aims: Paravalvular regurgitation (PVR) post transcatheter aortic valve implantation
(TAVI) is associated with poor survival however considerable variability exists between
incidences of PVR in current literature. The primary aim of this study was to establish the
incidence of PVR post-procedure, at 6-months and 1-year following TAVI. The secondary
aims of this study were to review the impact of moderate to severe PVR on mortality and
examine strategies employed to reduce PVR.
Methods: PubMed searches included articles detailing paravalvular leak rates post TAVI
published between 2002 and 2013. A systematic review and meta-analysis of current
literature to identify PVR incidence at three time points was performed using the random
effects model of DerSimonian and Laird. A total of 19 studies were identified. For post
procedure to 30 days, six months and one year; 7,652, 3,340 and 3,673 patients were
included in the analysis of incidence of PVR.
Results: The pooled analysis of PVR incidence was 8.21, 10.2 and 10.98% in each group
respectively. Moderate-severe PVR is associated with an increased risk of mortality
in all studies reviewed. Management strategies include balloon valvuloplasty, transcatheter aortic valve implantation-in-transcatheter aortic valve (TAVI-in-TAV), valve
repositioning and the use of occlusion devices.
Conclusion: Moderate-severe PVR occurs in approximately one in ten patients directly
following TAVI and does not appear to change significantly in the first year. A number of
feasible strategies can be employed to treat PVR. Consideration should be given to the
development of early-intervention management algorithms for this patient cohort in order
to improve survival post TAVI.
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Keywords
TAVI, paravalvula, regurgitation, Cribier Edwards, Medtronic CoreValve, Edwards Sapien
Citation
KE O Sullivan, A. Gough, S A Early, M Barry, R Segurado, D Sugrue, J Hurley. A Systematic Review and Meta-Analysis of the Incidence of Paravalvular Leak Incidence Post Procedure, Six Months and One-Year Following TAVI. Cardiology and Angiology An International Journal. 2013 July-December; 1(2): 34-46.