Journal article
Transcatheter reduction of paravalvular leaks: a systematic review and meta-analysis.
- Millán X Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
- Skaf S Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
- Joseph L Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada.
- Ruiz C Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York, USA.
- García E Division of Interventional Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Smolka G Division of Cardiology, Medical University of Silesia, Katowice, Poland.
- Noble S Department of Medical Specialties, Cardiology Division, Université de Genève, Geneva, Switzerland.
- Cruz-González I Division of Interventional Cardiology, Hospital Universitario de Salamanca, Salamanca, Spain.
- Arzamendi D Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Serra A Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Kliger C Division of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York, USA.
- Sia YT Centre Hospitalier Universitaire de Montréal, Université de Montréal, Montreal, Québec, Canada.
- Asgar A Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
- Ibrahim R Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada.
- Jolicœur EM Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada. Electronic address: marc.jolicoeur@icm-mhi.org.
- 2015-03-10
Published in:
- The Canadian journal of cardiology. - 2015
Anemia, Hemolytic
Clinical Trials as Topic
Echocardiography, Transesophageal
Evidence-Based Medicine
Heart Failure
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Mitral Valve
Prosthesis Failure
Randomized Controlled Trials as Topic
Reoperation
Risk Factors
Treatment Outcome
English
BACKGROUND
Significant paravalvular leak (PVL) after surgical valve replacement can result in intractable congestive heart failure and hemolytic anemia. Because repeat surgery is performed in only few patients, transcatheter reduction of PVL is emerging as an alternative option, but its safety and efficacy remain uncertain. In this study we sought to assess whether a successful transcatheter PVL reduction is associated with an improvement in clinical outcomes.
METHODS
We identified 12 clinical studies that compared successful and failed transcatheter PVL reductions in a total of 362 patients. A Bayesian hierarchical meta-analysis was performed using cardiac mortality as a primary end point. The combined occurrence of improvement in New York Heart Association functional class or hemolytic anemia and the need for repeat surgery, were used as secondary end points.
RESULTS
A successful transcatheter PVL reduction was associated with a lower cardiac mortality rate (odds ratio [OR], 0.08; 95% credible interval [CrI], 0.01-0.90) and with a superior improvement in functional class or hemolytic anemia, compared with a failed intervention (OR, 9.95; 95% CrI, 2.10-66.73). Fewer repeat surgeries were also observed after successful procedures (OR, 0.08; 95% CrI, 0.01-0.40).
CONCLUSIONS
A successful transcatheter PVL reduction is associated with reduced all-cause mortality and improved functional class in patients deemed unsuitable for surgical correction.
Significant paravalvular leak (PVL) after surgical valve replacement can result in intractable congestive heart failure and hemolytic anemia. Because repeat surgery is performed in only few patients, transcatheter reduction of PVL is emerging as an alternative option, but its safety and efficacy remain uncertain. In this study we sought to assess whether a successful transcatheter PVL reduction is associated with an improvement in clinical outcomes.
METHODS
We identified 12 clinical studies that compared successful and failed transcatheter PVL reductions in a total of 362 patients. A Bayesian hierarchical meta-analysis was performed using cardiac mortality as a primary end point. The combined occurrence of improvement in New York Heart Association functional class or hemolytic anemia and the need for repeat surgery, were used as secondary end points.
RESULTS
A successful transcatheter PVL reduction was associated with a lower cardiac mortality rate (odds ratio [OR], 0.08; 95% credible interval [CrI], 0.01-0.90) and with a superior improvement in functional class or hemolytic anemia, compared with a failed intervention (OR, 9.95; 95% CrI, 2.10-66.73). Fewer repeat surgeries were also observed after successful procedures (OR, 0.08; 95% CrI, 0.01-0.40).
CONCLUSIONS
A successful transcatheter PVL reduction is associated with reduced all-cause mortality and improved functional class in patients deemed unsuitable for surgical correction.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.cjca.2014.12.012
- PMID 25746018
- Persistent URL
- https://folia.unifr.ch/global/documents/220464
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