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P1790TAVI is associated with less patient-prosthesis-mismatch than surgical aortic valve repair of severe aortic stenosis: A systematic review and meta-analysis


 
 
 TAVI has shown to be non-inferior to surgical aortic valve replacement (sAVR) in terms of mortality for the treatment of intermediate and high-risk patients with severe aortic stenosis (AS).
 
 
 
 We sought to assess whether there is a difference on echocardiographic parameters up to 2 years after TAVI and sAVR
 
 
 
 We conducted a systematic review and a random-effect model meta-analysis of randomized controlled trials that compared TAVI and sAVR. The primary outcome was post-proceduralpatient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL).
 
 
 
 We identified 5 trials with a total of 5552 participants with AS, including 2777 patients randomized to TAVI and 2775 randomized to sAVR (Figure 1). TAVI was associated with a significant 35% relative risk reduction (95% CI [0.50–0.8), p=0.005) in moderate/severe post-procedural PPM. The effect was more evident in self- than balloon-expandable valves (p=0.029). Similar results were found in terms of post procedural EOA (RR=0.53, 95% CI [0.43–0.62]), and residual gradients (RR=0.54, 95% CI [0.32–0.76]). As expected, TAVI demonstrated higher rates of moderate/severe PVL (RR=9.41, 95% CI [5.22–16.96]). The results were sustainable at 2 years as seen in pooled increased EOA (pooled mean difference 0.48, 95% CI [0.24–0.72]), and the pooled decreased residual gradients of 0.58 (95% CI [0.77–0.25]) in favor of TAVI. The incidence of moderate/severe PVL remained also lower in sAVR patients (RR=10.39, 95% CI [4.80–22.46]).
 Figure 1. PRISMA flow diagram
 
 
 
 Our meta-analysis suggests that TAVI is associated with a lower risk of PPM, as well as higher EOA and lower residual gradients through 2 years of follow-up. This was accompanied by a higher incidence of moderate/severe PVL compared to sAVR. Future research should focus on the effect of these echocardiographic differences on clinical outcomes.
