Valvular performance and aortic regurgitation following transcatheter aortic valve replacement using Edwards valve versus CoreValve for severe aortic stenosis: A Meta-analysis.

OBJECTIVES: To compare incidence of aortic regurgitation (AR), paravalvular AR and valvular performance with Doppler hemodynamic parameters following transcatheter aortic valve replacement (TAVR) with Edwards valve (EV) versus CoreValve (CV). Currently, there are scarce data on post-TAVR echocardiographic outcomes comparing EV and CV.

METHODS: PubMed and the Cochrane Center Register of Controlled Trials were searched through May 2015. Twenty studies (n=11,244) comparing TAVR procedure that used EV (n=6445) and CV (n=4799) were included. End points were post-TAVR moderate to severe AR and paravalvular AR, effective orifice area (EOA), mean trans-aortic pressure gradient (MPG), peak trans-aortic pressure gradient (PPG) and left ventricular ejection fraction (LVEF). The mean difference (MD) or relative risk (RR) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance.

RESULTS: Moderate to severe AR and paravalvular AR were significantly lower in EV group (RR: 0.57, CI: 0.52-0.63, p<0.00001 and RR: 0.40, CI: 0.25-0.63, p<0.0001 respectively) compared to CV group. EOA and PPG were not significantly different between EV and CV groups. MPG was significantly lower among patients in CV group (MD: 1.08, CI: 0.05-2.10, p=0.04). LVEF was significantly higher in patients in EV group (MD: 2.26, CI: 0.77-3.74, p=0.03).

CONCLUSIONS: This study showed CV is associated with higher incidence of post-TAVR moderate to severe paravalvular AR. Echocardiographic valvular performance measures (MPG, LVEF) showed minimal but significant difference, which may not be clinically significant.