Thirty-day incidence of stroke after transfemoral transcatheter aortic valve implantation: meta-analysis and mixt-treatment comparison of self-expandable versus balloon-expandable valve prostheses

Abstract

Aims Stroke is a major complication after transcatheter aortic valve implantation (TAVI). Although multifactorial, it remains unknown whether the valve deployment system itself has an impact on the incidence of early stroke. We performed a meta- and network analysis to investigate the 30-day stroke incidence of self-expandable (SEV) and balloon-expandable (BEV) valves after transfemoral TAVI. Methods and results Overall, 2723 articles were searched directly comparing the performance of SEV and BEV after transfemoral TAVI, from which 9 were included (3086 patients). Random effects models were used for meta- and network meta-analysis based on a frequentist framework. Thirty-day incidence of stroke was 1.8% in SEV and 3.1% in BEV (risk ratio of 0.62, 95% confidence interval (CI) 0.49–0.80, p = 0.004). Treatment ranking based on network analysis (P-score) revealed CoreValve with the best performance for 30-day stroke incidence (75.2%), whereas SAPIEN had the worst (19.0%). However, network analysis showed no inferiority of SAPIEN compared with CoreValve (odds ratio 2.24, 95% CI 0.70–7.2). Conclusion Our analysis indicates higher 30-day stroke incidence after transfemoral TAVI with BEV compared to SEV. We could not find evidence for superiority of a specific valve system. More randomized controlled trials with head-to-head comparison of SEV and BEV are needed to address this open question. Graphic abstract

Comparison of outcomes of self-expanding versus balloon-expandable valves for transcatheter aortic valve replacement: a meta-analysis of randomized and propensity-matched studies

“…Thirty-day stroke is a significant complication after TAVR, and its relationship with THV types remains unclear. Seppelt et al reported stroke rates of 1.8% and 3.1% at thirty days after TAVR with SEV and BEV, respectively [ 37 ]. On the contrary, our research findings revealed that the early stroke incidence rates for Evolut SEV, ACURATE SEV, and SAPIEN BEV were 3.30%, 2.60%, and 1.90%, respectively.…”

Short- and Long-term Clinical Outcomes of Balloon-expandable Versus Self-expanding Valves in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-analysis

“…Several studies show a higher incidence of stroke with BEV than SEV while some show similar stroke rates. 29,30 A possible explanation for the higher stroke rate with the BEV design includes rapid ventricular pacinginduced cerebral hypoperfusion during BEV deployment. 31 Post-TAVR strokes and silent brain infarcts are associated with post-procedure early cognitive decline, leading to increased mortality and morbidity.…”