Transcatheter Aortic Valve Implantation With or Without Predilation: A Meta-Analysis

Federico Conrotto, Fabrizio D'Ascenzo, Luca Franchin, Francesco Bruno, Mamas A. Mamas, Konstantinos Toutouzas, Thomas Cuisset, Florence Leclercq, Nicolas Dumonteil, Azeem Latib, Luis Nombela-Franco, Andreas Schaefer, R. David Anderson, Laura Marruncheddu, Guglielmo Gallone, Ovidio De Filippo, Michele La Torre, Mauro Rinaldi, Pierluigi Omedè, Stefano SalizzoniGaetano Maria De Ferrari

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

AIMS: To evaluate the impact of systematic predilation with balloon aortic valvuloplasty (BAV) on transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We performed a systematic meta-analysis investigating patients undergoing TAVI with systematic BAV vs no BAV in RCT or in adjusted studies. Device success was the primary endpoint, while all-cause mortality, 30-day moderate/severe aortic regurgitation (AR), stroke, permanent pacemaker implantation (PPI) and acute kidney injury (AKI) were the secondary endpoints. Subanalysis according to design of the study (RCT and adjusted analysis) and to the type of valve (balloon-expandable [BE] vs self-expanding [SE]) were conducted. We obtained data from 15 studies, comprising 16,408 patients: 10,364 undergoing BAV prior to TAVI and 6,044 in which direct TAVI has been performed. At 30-day follow-up, BAV did not improve the rate of device success in the overall population (OR, 1.09; 95% CI, 0.90-1.31), both in SE (OR, 0.93; 95% CI, 0.60-1.45) and in BE (OR, 1.16; 95% CI, 0.88-1.52) valves. Between BAV and direct TAVI, no differences in secondary outcomes were observed neither in overall population nor according to valve type between BAV and direct TAVI strategies. All endpoints results were consistent between RCTs and adjusted studies except for postdilation rate that did not differ in observational studies (OR, 0.70; 95% CI, 0.47-1.04), while it was lower in BAV when only RCTs were included in the analysis (OR, 0.48; 95% CI, 0.24-0.97). CONCLUSIONS: Direct TAVI is feasible and safe compared to predilation approach with similar device success rates and clinical outcomes. Direct TAVI could represent a first-choice approach in contemporary TAVI procedures.

Original languageEnglish (US)
Pages (from-to)E104-E113
JournalThe Journal of invasive cardiology
Volume34
Issue number2
StatePublished - Feb 1 2022

Keywords

  • aortic stenosis
  • balloon aortic valvuloplasty
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • General Medicine

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