Abstract
Since almost a decade, the use of bioprosthetic valves (BPV) has been increasing for the replacement of stenosed aortic valves. With the increasing use, a rise in the BPV failure is noted considering their limited durability. Redo-surgical aortic valve replacement (rSAVR) is by far the only gold standard treatment modality for replacement of deteriorated BPV. Recently, valve in valve-transcatheter aortic valve replacement (ViV-TAVR) is explored as the alternative minimally invasive procedure compared to the gold standard rSAVR. However, its efficacy remains the major concern. Hence, we aimed to conduct the meta-meta-analysis to evaluate the safety and efficacy of ViV-TAVI compared to redo-SAVR. Following PRISMA guidelines, we searched for a meta-analysis comparing the safety and efficacy of ViV-TAVR vs rSAVR from PubMed and included 9 analyses which compared the two modalities head-to-head in terms of outcomes and complications. We included various complications and outcomes like 30-day mortality, long-term mortality, procedural mortality, hospital readmission, and complications including acute MI, stroke, major bleeding, vascular complications, acute kidney injury, and new pacemaker implantation. We carried out a meta-meta-analysis by obtaining pooled odds ratio, 95% CI using random effect models. We found out that there was a significantly low risk of 30-day mortality (pooled OR:0.60; 95%CI:0.53–0.68; p < 0.00001) with no heterogeneity (p = 0.53; I2 = 0%) with ViV-TAVR vs rSAVR. Also, there was a reduced risk of procedural mortality (pooled OR:0.52; 95%CI:0.27–0.98; p = 0.04) with 0% heterogeneity with ViV-TAVR vs rSAVR. ViV-TAVI is associated with significantly reduced risk of 30-day mortality compared to rSAVR. Our meta-meta-analysis reinforces the safety and efficacy of ViV-TAVR as the procedure of choice for failed bioprosthetic (BP) valves in high-risk candidates.
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Conceptualization: Surya Kiran Aedma, Nida Khan. Methodology: Urvish K. Patel. Acquisition of data: Nida Khan, Abbas Altamimi, Nawal Ali, Jigisha Rakholiya. Formal analysis and investigation: Urvish K. Patel, Surya Kiran Aedma. Writing—original draft preparation: Surya Kiran Aedma, Nida Khan, Abbas Altamimi, Nawal Ali, Shubhi Jain, Karanrajsinh Raol, Sowmya Madireddy, Jigisha Rakholiya, Abdur Raheem, Rutikbhai Desai. Writing—review, critical feedback, and editing: Urvish K. Patel, Rizwan Rabbani, Suveenkrishna Pothuru. Funding acquisition: None. Resources: Supervision: Suveenkrishna Pothuru.
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Aedma, S.K., Khan, N., Altamimi, A. et al. Umbrella Meta-analysis Evaluating the Effectiveness of ViV-TAVI vs Redo SAVR. SN Compr. Clin. Med. 4, 63 (2022). https://doi.org/10.1007/s42399-022-01136-x
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DOI: https://doi.org/10.1007/s42399-022-01136-x