Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve Implantation with Self-Expanding Versus Balloon-Expandable Valves

Abstract Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo-surgery in patients with failed surgical bioprostheses. It remains unclear whether outcomes vary when using either self-expanding (SE) or balloon-expandable (BE) valves. The aim of this study was to compare outcomes between SE and BE transcatheter heart valves when used for ViV TAVI. A systematic review of PubMed, MEDLINE and EMBASE was performed identifying studies reporting outcomes following ViV TAVI. Event rates were pooled for meta-analysis using a random-effects model. The primary outcome was all-cause mortality at 12-months. Secondary outcomes included 30-day and 3-year mortality in addition to standard post-procedural safety outcomes as per the Valve Academic Research Consortium (VARC-2) criteria. Nineteen studies reporting outcomes for 1,772 patients were included: 924 in the SE group and 848 patients in the BE group. There was no significant difference in all-cause mortality at 12-months (SE 10.3% vs BE 12.6%, p=0.165, I2=0%), or 3-years (SE 21.2% vs BE 31.2%, p=0.407, I2=63.79). SE valves had lower post-procedural transvalvular gradients and acute kidney injury, but higher rates of pacemaker insertion, moderate or severe paravalvular regurgitation and need for ≥2 valves (all p