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Umbrella Meta-analysis Evaluating the Effectiveness of ViV-TAVI vs Redo SAVR

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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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Data Availability

The data is collected from the studies published online, publicly available, and specific details related to data and/or analysis will be made available upon request.

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Authors and Affiliations

  1. Department of Internal Medicine, Carle Illinois College of Medicine, Urbana, IL, USA

    Surya Kiran Aedma

  2. Department of Internal Medicine, Jinnah Sindh Medical University, Sindh, Pakistan

    Nida Khan

  3. Department of Emergency Medicine, Amiri Hospital, Sharq, Kuwait

    Abbas Altamimi

  4. Liaquat University of Medical Health and Science, Sindh, Pakistan

    Nawal Ali

  5. Department of Internal Medicine, Gujarat Medical Education and Research Society Medical College, Gotri, Gujarat, India

    Shubhi Jain

  6. Department of Internal Medicine, Gujarat Medical Education and Research Society Medical College and General Hospital, Gandhinagar, Gujarat, India

    Karanrajsinh Raol

  7. Department of Internal Medicine, Mamata Medical College, Khammam, Telangana, India

    Sowmya Madireddy

  8. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Jigisha Rakholiya

  9. Department of Internal Medicine, Texas Tech University Health Sciences Center at Permian Basin, Odessa, TX, USA

    Abdur Raheem

  10. Department of Internal Medicine, University of North Carolina Cardiology at Nash, Rocky Mount, NC, USA

    Rutikbhai Desai

  11. Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, Gustave L. Levy Pl, New York, NY, 10029, USA

    Urvish K. Patel

  12. Temple University Hospital, Philadelphia, PA, USA

    Rizwan Rabbani

  13. Department of Internal Medicine, Ascension Via Christi Hospital, Manhattan, KS, USA

    Suveenkrishna Pothuru

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Contributions

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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Correspondence to Urvish K. Patel.

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Though this article does not contain any studies with direct involvement of human participants or animals performed by any of the authors, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Surya Kiran Aedma and Nida Khan are equally contributing first authors

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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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