Abstract 4368425: Comparison of Self-Expandable and Balloon-Expandable Valves in Conduction Outcomes Following TAVR: A Meta-Analysis of 35,946 Patients

Abstract

Background: Conduction disturbances, including high-degree atrioventricular block (HAVB) and the need for permanent pacemaker implantation (PPI), have been reported following transcatheter aortic valve replacement (TAVR) with emergent device techniques. Differences in valve structure and deployment mechanisms may impact the incidence of these complications, though the magnitude and consistency of this association remain uncertain. Research Question: This study aimed to test the hypothesis that self-expandable valves carry a higher risk of PPI and HAVB than balloon expandable valves in TAVR patients, even after correcting for confounding variables. Methods: A systematic review and meta-analysis were conducted to compare PPI and HAVB incidence between self expandable and balloon expandable valves post-TAVR. Random-effects models using the DerSimonian-Laird method were applied to pool both unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals and p values. Heterogeneity was evaluated using the I 2 statistic. Publication bias was assessed through funnel plots and Egger’s regression. Results: Thirty-seven studies involving 35,946 patients met our inclusion criteria. Self expandable valves were associated with significantly greater risks of PPI {unadjusted OR 2.23 [1.83–2.70] p < 0.0001; I 2 56.9%} and HAVB {unadjusted OR 2.22 [1.61-3.06] p < 0.04; I 2 39.2%} compared to balloon expandable valves. These associations persisted following adjustment for confounding variables with adjusted OR 2.21 [1.46–3.35] p <0.26; I 2 23.1% for PPI and OR 1.98 [ 0.73-5.38] p <0.06; I 2 58.4% for HAVB (Figures 1 and 2). Funnel plots are symmetrical for HAVB, while adjusted PPI plots showed some asymmetry. However, Egger’s test indicated no significant publication bias. Conclusion: This study demonstrates higher odds of PPI and HAVB following TAVR with self expandable valves compared to balloon expandable valves, consistent even after removing confounding variables, which was not mentioned in the previous studies. These findings highlight pre-procedural planning of device selection, especially in high-risk patients.