Journal article
Clinical Outcomes of the Self-Expandable Evolut R Valve Versus the Balloon-Expandable SAPIEN 3 Valve in Transcatheter Aortic Valve Implantation: A Meta-Analysis and Systematic Review
Cardiovascular revascularization medicine, Vol.25, pp.57-62
04/2021
DOI: 10.1016/j.carrev.2020.10.002
PMID: 33160895
Abstract
Transcatheter aortic valve replacement (TAVR) is now indicated in patients with symptomatic aortic stenosis and low, moderate, and high surgical risk. There are multiple types of valves available in TAVR. SAPIEN 3, and Evolut R are two of the most commonly used valves.
We conducted a systematic review and meta-analysis of all studies that compared SAPIEN 3 vs Evolut R in patients undergoing TAVR. The primary endpoint of this meta-analysis was 30-day mortality. Secondary outcomes included major of life-threatening bleeding, risk of stroke, need of permanent pacemaker implantation, and risk of moderate to severe paravalvular regurgitation (PVR).
We included a total of 9 studies. One study was a randomized clinical trial, five were prospective observational studies and three were retrospective. 30-day mortality rate was similar between SAPIEN 3 and Evolut R (odds ratio (OR) 1.19; 95% confidence interval (CI) 0.72 to 1.93; p = 0.47). The risk of major or life-threatening bleeding (OR of 0.83, 95% CI 0.50 to 1.39; p = 0.48), and the risk of stroke (OR of 0.82, 95% CI 0.38 to 1.78; p = 0.62) were also similar between the two types of valves. Compared to SAPIEN 3, Evolut R was associated with statistically significant risk of permanent pacemaker implantation (OR of 1.40, 95% CI 1.15 to 1.70; p = 0.0007), and moderate to severe PVR (OR of 2.56, 95% CI 1.14 to 5.74; p = 0.02).
At 30 day follow up, both Evolut R and SAPIEN 3 shared similar risks of 30-day mortality, major or life-threatening bleeding, and stroke; however greater odds of pacemaker placement implantation and moderate to severe PVR were associated with Evolut R.
•There are limited head-to-head comparisons of the newer generations of transcatheter aortic valves.•Evolut R and SAPIEN 3 valves were associated with a similar risk of 30-day mortality, life-threatening bleeding, and stroke in patients undergoing transcatheter aortic valve replacement (TAVR)•Evolut R was associated with higher risk of permanent pacemaker placement implantation and moderate to severe paravalvular regurgitation (PVR).•A patient-specific device implantation approach is recommended to decrease the rate adverse events associated with TAVR.
Details
- Title: Subtitle
- Clinical Outcomes of the Self-Expandable Evolut R Valve Versus the Balloon-Expandable SAPIEN 3 Valve in Transcatheter Aortic Valve Implantation: A Meta-Analysis and Systematic Review
- Creators
- Abdullah Al-abcha - Michigan State UniversityYehia Saleh - Houston MethodistLawrenshey Charles - Michigan State UniversityRohan Prasad - Michigan State UniversityZulfiqar Qutrio Baloch - Michigan State UniversityMohanad A. Hasan - Ochsner Medical CenterGeorge S. Abela - Michigan State University
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.25, pp.57-62
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.carrev.2020.10.002
- PMID
- 33160895
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Number of pages
- 6
- Language
- English
- Date published
- 04/2021
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984755388602771
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