P6302Normal values for doppler echocardiographic assessment of prosthetic valve function after TAVR - A systematic review and meta-analysis

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has emerged as an attractive, minimally invasive alternative to surgical AVR in patients at high and intermediate surgical risk. Particularities specific to TAVR and a rapidly growing number of available prosthesis make post-procedural assessment of valve function challenging. Aim of the present analysis was to collect and pool all available data cin the literature regarding normal doppler values for transcatheter prosthetic heart valves and to provide a comprehensive overview. Methods: A PRISMA checklist-guided systematic review and meta-analysis of prospective observational studies or national and device specific registries or randomized clinical trials was conducted. Studies were identified by searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials and LILACs from 01/2000 to 03/2017. Results: Out of 240 abstracts, 155 studies (entailing a total of 27,159 patients) reported echocardiographic parameters. 55 studies in 7778 patients for the CoreValve®, SAPIEN valve: 35 studies with 4942 patients, SAPIEN XT: 32 studies with 3557, SAPIEN III:12 studies with 6231 patients, Direct Flow Medical Transcatheter valve: 12 studies with 816 patients, LOTUS™ Valve: 8 studies with 984 patients, Evolut™ R valve:4 studies with 872 patients, JenaValve™: 4 studies with 206 patients, ACURATE TA™:10 studies with 1161 patients, ACURATE neo™ valve: 5 studies with 273 patients, Portico™ valve: 4 studies with 191 patients for the and the Engager™ valve:4 studies with 148 patients. The pooled means and standard deviations for all available TAVR prosthesis were classified according to implanted valve size and time since implantation. We observed a mild increase in the different doppler indices from the discharge to the long term follow up (Fig. 1). However the changes were minor reassuring the stable haemodynamic performance of the different TAVR prosthesis. Second and third generation successors of the available TAVR prosthesis tended to show superior hemodynamic characteristics as compared to the first generation devices. We found no significant difference in mean transprosthetic gradient between the Edwards Sapien and the Sapien XT (9.85 ± 4.19 mmHg, vs. 9.94 ± 4.7 mmHg, p = 0.40). Interestingly the analysis revealed a significant higher mean gradient of the Edwards Sapien III valve as compared to the Edwards Sapien (10.45 ± 4.91 vs. 9.85 ± 4.19 mmHg. P < 0.001) and the Edwards Sapien XT (10.45 ± 4.91 vs. 9.94 ± 4.7 mmHg, p < 0.001). In contrast to this, the newer Medtronic EvolutTM R showed significant lower mean gradients at baseline as compared to the Medtronic CoreValve® (7.41 ± 4.7 vs. 8.53 ± 4.7, p < 0.001). Conclusions: The present study firstly describes a pooled analysis of normal values for all available TAVR prosthesis to empower physicians with a reliable tool to perform follow-up echocardiographic assessment in TAVR patients and to safely identify patients with prostheses dysfunction.