Transcatheter aortic valve replacement with new-generation devices: A systematic review and meta-analysis

Objective The aim of this study was to conduct a weighted meta-analysis to determine the rates of acute (≤ 30 days) major outcomes after (TAVR) with second-generation devices. Methods A comprehensive search of multiple electronic databases from January 2011 to May 2017 was conducted using predefined criteria. New-generation TAVR devices were defined as any device which received CE mark approval or is still under evaluation for CE marking after CoreValve and SAPIEN XT prostheses. Results A total of 37 studies including 10,822 patients met inclusion criteria and were included in the analysis. Devices investigated in the studies were the following: SAPIEN 3 (n = 5423, 45.9%), Lotus Valve (n = 3007, %), Portico (n = 130, 1.1%), JenaValve (n = 345, 2.9%), Symetis Acurate (n = 1314, 11,1%), and Evolut R (n = 1603, 13.6%). Thirty-day all-cause and cardiovascular 30-day death were 2.2% (95% CI: 1.6% to 2.8%) and 1.6% (95% CI: 0.9% to 2.3%), respectively; Any stroke and major/disabling stroke occurred at a pooled estimate rate of 2.6% (95% CI: 2.0% to 3.3%) and 0.9% (95% CI: 0.2% to 1.6%), respectively; life-threatening bleeding, 3.9% (95% CI: 2.9% to 5.0%); major vascular complications, 4.5% (95% CI: 3.7% to 5.4%); pacemaker implantation, 16.2% (95% CI: 12.7% to 19.6%); more than mild aortic regurgitation, 1.6% (95% CI: 0.9 to 2.3). Conclusions Second-generation TAVR devices are associated with very low mortality and major complications rates at 30-day, and improved prosthesis performance with < 2% of patients having more than mild post-procedural aortic regurgitation. On the other hand, the need for pacemaker implantation seems to remain an unresolved issue, and warrants further investigation.