A Systematic Review and Meta-Analysis of the Incidence of Paravalvular Leak Incidence Post Procedure, Six Months and One-Year Following TAVI

Abstract

Aims: Paravalvular regurgitation (PVR) post transcatheter aortic valve implantation (TAVI) is associated with poor survival however considerable variability exists between incidences of PVR in current literature. The primary aim of this study was to establish the incidence of PVR post-procedure, at 6-months and 1-year following TAVI. The secondary aims of this study were to review the impact of moderate to severe PVR on mortality and examine strategies employed to reduce PVR. Methods: PubMed searches included articles detailing paravalvular leak rates post TAVI published between 2002 and 2013. A systematic review and meta-analysis of current literature to identify PVR incidence at three time points was performed using the random effects model of DerSimonian and Laird. A total of 19 studies were identified. For post procedure to 30 days, six months and one year; 7,652, 3,340 and 3,673 patients were included in the analysis of incidence of PVR. Results: The pooled analysis of PVR incidence was 8.21, 10.2 and 10.98% in each group respectively. Moderate-severe PVR is associated with an increased risk of mortality in all studies reviewed. Management strategies include balloon valvuloplasty, transcatheter aortic valve implantation-in-transcatheter aortic valve (TAVI-in-TAV), valve repositioning and the use of occlusion devices. Conclusion: Moderate-severe PVR occurs in approximately one in ten patients directly following TAVI and does not appear to change significantly in the first year. A number of feasible strategies can be employed to treat PVR. Consideration should be given to the development of early-intervention management algorithms for this patient cohort in order to improve survival post TAVI.