Immediate transcatheter aortic valve replacement versus temporizing balloon aortic valvuloplasty in severe aortic stenosis: A systematic review and meta-analysis immediate TAVR vs. temporizing BAV.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a first-line therapy for severe aortic stenosis (AS). In patients with contraindications to immediate TAVR, temporizing balloon aortic valvuloplasty (BAV) may be performed to stabilize patients prior to TAVR. The relative efficacy and safety of TAVR with or without temporizing BAV remains inadequately described.

Methods: We searched PubMed, Embase, and Cochrane databases for studies comparing TAVR with and without temporizing BAV in patients with severe AS. Random-effects models were used to calculate pooled odds, risk ratios (RRs) and mean differences with 95 % confidence intervals (CIs).

Results: Nine studies (59,205 patients: 95.7 % immediate TAVR, 4.3 % BAV + TAVR) met inclusion criteria. Mean age was 82.9 ± 6.6 years old, and 45.9 % were males. Patients in the TAVR group were a mean difference of 1 year younger with no difference in gender distribution between groups. Direct TAVR was associated with a lower risk of 30-day all-cause mortality than BAV + TAVR (RR = 0.62; 95 % CI 0.41 to 0.93; p = 0.02). There were no significant differences in risks of post-procedural pacemaker implantation, myocardial infarction, cardiac tamponade, major vascular complications, ischemic stroke, major bleeding, 2+ or greater aortic regurgitation grade or acute kidney injury.

Conclusion: While immediate TAVR was associated with slightly lower short-term mortality compared to BAV + TAVR in patients with severe AS, other binary endpoints were equivalent. This potential mortality difference should be considered when offering BAV + TAVR in patients with contraindications to immediate TAVR. Randomized studies are required to confirm these results.