• J Eval Clin Pract · Aug 2021

    Meta Analysis

    Clinical outcomes after transcatheter aortic valve replacement in South America: A centre-level systematic review and meta-analysis of observational data.

    • Carlos Pablo Boissonnet, Mariano Aníbal Giorgi, Lucila Carosella, Carola Brescacin, Jerónimo Pissinis, and Javier Norberto Guetta.
    • Health Economics and Technology Assessment Unit, Instituto Universitario CEMIC, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina.
    • J Eval Clin Pract. 2021 Aug 1; 27 (4): 785-798.

    ObjectivesTo estimate in-hospital and 30-day outcomes after transcatheter aortic valve replacement (TAVR) in South America through a systematic review and meta-analysis of observational data.MethodsWe comprehensively searched for papers published in peer-reviewed medical journals and for abstracts presented in medical conferences of the region from 1 September 2008, through 29 June 2020, using predefined criteria. We included single-centre studies on TAVR populations with ≥10 patients from South America reporting any in-hospital or 30-day clinical outcome.ResultsFifty-five cohorts from seven countries, pooling 3001 patients, were included in a random-effects meta-analysis. Self-expandable prostheses were the most frequently implanted. Pooled estimate of procedure success by VARC2 criteria was 90.0% (95%CI 81.8%-94.7%; I2 75.0%). The pooled estimate rates of the outcomes were as follow: post-procedure moderate or severe aortic regurgitation, 9.7% (95%CI 6.0%-15.4%; I2 65.4%), in-hospital cardiac tamponade, 4.0% (95%CI 2.5%-6.6%; I2 0%), in-hospital stroke, 4.1% (95%CI 2.9%-5.7%; I2 0%), in-hospital major vascular complication, 7.8% (95%CI 5.2%-11.5%; I2 22.3%), in-hospital permanent pacemaker implantation, 19.4% (95%CI 15.9%-23.4%; I2 53.8%), in-hospital mortality, 8.0% (95%CI 6.7%-9.6%; I2 0%), and 30-day mortality, 9.7% (95%CI 7.9%-11.8%; I2 26.4%).ConclusionAs compared with published international registries, the overall results of TAVR in South America seemed underrated. Significant heterogeneity was observed in procedural success, pacemaker requirement, and post-procedure moderate or severe aortic regurgitation. This study provides a real-life framework for the analysis of the performance of this technology in the region, intended to be a starting point for quality improvement.© 2020 John Wiley & Sons Ltd.

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