Meta-Analysis Comparing Transcatheter Aortic Valve Implantation With Balloon Versus Self-Expandable Valves

Two transcatheter aortic valve systems are currently in use in the United States; balloon-expandable valves (BEV) and the self-expanding valve (SEV). However, comparative data outcomes between the 2 systems are limited, as only one randomized trial (RCT) performed a head-to-head comparison between BEVs and SEVs. However, there are several RCTs comparing BEV or SEV to surgical valve replacement. In this analysis, we used Bayesian network meta-analysis techniques to compare BEVs and SEVs. The primary outcome was all-cause mortality at maximum follow-up. Secondary outcomes were cardiovascular mortality, stroke, pacemaker implantation, reintervention, heart failure hospitalization, and moderate-severe paravalvular leak (PVL.). Eight RCTs with 8,095 patients were included. With the exception of less pacemaker implantation in BEV versus SEV (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.11 to 0.77, I-2 = 51%), there was no difference between BEV and SEV in 30-day outcomes. During long-term follow-up (mean 3 +/- 2 years); there was no difference between BEV and SEV in all-cause mortality (hazard ratio [HR] 1.1, 95% CI 0.87 to 1.5, I-2 = 19.6%), cardiovascular mortality (HR 1.1, 95% CI 0.73 to 1.6, I-2 = 18.5%), stroke (HR 1.3, 95% CI 0.73 to 2.1, I-2 = 16.9%), hospitalization (HR 0.87, 95% CI 0.41 to 1.6, I-2 = 62%), and reintervention (HR 0.68, 95% CI 0.2 to 2.3, I-2 = 62%). New pacemaker implantation and PVL were significantly less in BEV group (HR 0.45, 95% CI 0.24 to 0.80, I-2 = 38.2%), and (HR 0.03, 95% CI 0.0004 to 0.28, I-2 = 79%), respectively. In conclusion, similar outcomes were seen following transcatheter aortic valve implantation with BEV and SEV with the exception of higher rates of pacemaker implantation and PVL in SEV group. (C) 2019 Elsevier Inc. All rights reserved.