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Open Access 01-05-2021 | Stroke | Original Paper

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

Authors: Philipp C. Seppelt, Silvia Mas-Peiro, Roberta De Rosa, Zisis Dimitriasis, Andreas M. Zeiher, Mariuca Vasa-Nicotera

Published in: Clinical Research in Cardiology | Issue 5/2021

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

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Title: 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
Authors: Philipp C. Seppelt
Silvia Mas-Peiro
Roberta De Rosa
Zisis Dimitriasis
Andreas M. Zeiher
Mariuca Vasa-Nicotera
Publication date: 01-05-2021
Publisher: Springer Berlin Heidelberg
Keywords: Stroke
Transcatheter Aortic Valve Implantation
Published in: Clinical Research in Cardiology / Issue 5/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-020-01775-x

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Methods and results

Conclusion

Graphic abstract

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