Yasmin Farah, Moeed Abdul, Iqbal Kinza, Ali Abraish, Kumar Ashish, Basit Jawad, Hamza Mohammad, Dani Sourbha S, Kalra Ankur
Yale University School of Medicine, New Haven CT 06511, USA.
Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Int J Cardiol Heart Vasc. 2025 Feb 24;57:101627. doi: 10.1016/j.ijcha.2025.101627. eCollection 2025 Apr.
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as a feasible alternative to reoperative surgery in patients with degenerated surgical bio-prosthesis. However, data regarding the choice of valve type in ViV-TAVI remain inconclusive. This -analysis compares the procedural and clinical outcomes of self-expanding (SE) vs. balloon-expandable (BE) valves in ViV-TAVI. MEDLINE and Scopus were queried to identify studies reporting outcomes of ViV-TAVI by SE/BE valve type or comparing outcomes between SE or BE valves for ViV-TAVI. The primary outcome was incidence of all-cause mortality at 30 days. Data were presented as incidence of outcomes, analyzed via random effects model using inverse variance method with 95 % confidence intervals. Further incidence rates of primary and secondary outcomes were presented as subgroups of BE and SE, with comparison in incidence rates between the subgroups made using p-interaction of proportions. 27 studies with 13,182 patients (SE: 7346; BE: 5836) were included. There were no significant differences between the BE vs. SE valves in 30-day mortality (BE 4 % vs. SE 3 %, p = 0.44), 1-year mortality (BE 12 % vs. SE 10 %, p = 0.60), and moderate-to-severe AR at 1 year (BE 1 % vs. SE 3 %, p = 0.36). However, patients with SE valves had higher rates of new permanent pacemaker insertion (BE 4 % vs. SE 9 %, p = 0.0019). There were no significant differences in the incidence of 30-day safety outcomes, including stroke, AKI, coronary obstruction, major bleeding, and major vascular complications. Both BE and SE valve types showed comparable mortality and safety outcomes in ViV-TAVI, except pacemaker insertion, which was higher in SE compared with BE valves.
瓣中瓣经导管主动脉瓣植入术（ViV-TAVI）已成为外科生物假体退化患者再次手术的一种可行替代方案。然而，关于ViV-TAVI中瓣膜类型选择的数据仍无定论。本分析比较了ViV-TAVI中自膨胀（SE）瓣膜与球囊扩张（BE）瓣膜的手术和临床结果。检索了MEDLINE和Scopus数据库，以确定报告按SE/BE瓣膜类型划分的ViV-TAVI结果或比较ViV-TAVI中SE或BE瓣膜之间结果的研究。主要结局是30天时全因死亡率。数据以结局发生率表示，采用逆方差法通过随机效应模型进行分析，并给出95%置信区间。主要和次要结局的进一步发生率以BE和SE的亚组形式呈现，亚组之间的发生率比较采用比例的p交互作用。纳入了27项研究，共13182例患者（SE：7346例；BE：5836例）。BE瓣膜与SE瓣膜在30天死亡率（BE为4%，SE为3%，p = 0.44）、1年死亡率（BE为12%，SE为10%，p = 0.60）和1年时中重度主动脉瓣反流（BE为1%，SE为3%，p = 0.36）方面无显著差异。然而SE瓣膜患者新植入永久性起搏器的发生率更高（BE为4%，SE为9%，p = 0.0019）。在30天安全性结局的发生率方面，包括中风、急性肾损伤、冠状动脉阻塞、大出血和主要血管并发症，均无显著差异。在ViV-TAVI中，BE和SE两种瓣膜类型的死亡率和安全性结局相当，但SE瓣膜植入起搏器的发生率高于BE瓣膜。
