Effectiveness and safety of transcatheter aortic valve replacement in treatment of aortic regurgitation: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Yang ¹ , WANG Zhenxiu ¹ , CHEN Hao ¹ , WANG Jialu ¹ , LIU Hongxu ¹ , WAN Zunhui ² , DONG Shuai ² ,  SONG Bing ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding author：

SONG Bing, Email: songbinldyy@163.com

Keywords：

Transcatheter aortic valve replacement; aortic valve insufficiency; safety; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202111093

Video：

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Objective To investigate effectiveness and safety of transcatheter aortic valve replacement in the treatment of aortic regurgitation. Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data and VIP were searched from inception to August 2021. According to the criteria of inclusion and exclusion, two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. Then, Stata 16.0 software was used for meta-analysis. Subgroup meta-analysis of valve type used and study type was performed. Results Twenty-five studies (12 cohort studies and 13 single-arm studies) were included with 4 370 patients. Meta-analysis results showed that an incidence of device success was 87% (95%CI 0.81-0.92). The success rate of the new generation valve subgroup was 93% (95%CI 0.89-0.96), and the early generation valve subgroup was 66% (95%CI 0.56-0.75). In addition, the 30-day all-cause mortality was 7% (95%CI 0.05-0.10), the 30-day cardiac mortality was 4% (95%CI 0.01-0.07), the incidence of pacemaker implantation was 10% (95%CI 0.08-0.13), and the incidence of conversion to thoracotomy was 2% (95%CI 0.01-0.04). The incidence of moderate or higher paravalvular aortic regurgitation was 6% (95%CI 0.03-0.09). Conclusion Transcatheter aortic valve replacement for aortic regurgitation is safe and yields good results, but some limitations can not be overcome. Therefore, multicenter randomized controlled trials are needed to confirm our results.

Citation： CHEN Yang, WANG Zhenxiu, CHEN Hao, WANG Jialu, LIU Hongxu, WAN Zunhui, DONG Shuai, SONG Bing. Effectiveness and safety of transcatheter aortic valve replacement in treatment of aortic regurgitation: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(2): 240-248. doi: 10.7507/1007-4848.202111093 Copy

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2.	Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
3.	李忠城, 苏建, 李菊香. 经导管主动脉瓣置换术对于外科低危主动脉瓣狭窄患者有效性和安全性的Meta分析. 临床心血管病杂志, 2019, 35(9): 835-841.
4.	金力波, 吴昊, 冯卫中, 等. 不同路径行经导管主动脉瓣置换术安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2021, 28(7): 765-776.
5.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
6.	周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识 (2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
7.	Virtanen MPO, Airaksinen J, Niemelä M, et al. Comparison of survival of transfemoral transcatheter aortic valve implantation versus surgical aortic valve replacement for aortic stenosis in low-risk patients without coronary artery disease. Am J Cardiol, 2020, 125(4): 589-596.
8.	Asai T, Hosoba S, Suzuki T, et al. Postinfarction ventricular septal defect: Right ventricular approach-the extended "sandwich" patch. Semin Thorac Cardiovasc Surg, 2012, 24(1): 59-62.
9.	Barik R. Transcatheter closure of post-myocardial infarction ventricular defect: Where are we? Indian Heart J, 2016, 68(1): 99-101.
10.	Amrane H, Deeb GM, Popma JJ, et al. Causes of death in intermediate-risk patients: The randomized surgical replacement and transcatheter aortic valve implantation trial. J Thorac Cardiovasc Surg, 2019, 158(3): 718-728.
11.	Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
12.	Nadeau-Routhier C, Marsit O, Beaudoin J. Current management of patients with severe aortic regurgitation. Curr Treat Options Cardiovasc Med, 2017, 19(2): 9.
13.	Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
14.	Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
15.	Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? Eur Heart J, 2005, 26(24): 2714-2720.
16.	Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: Comprehensive review and present status. Tex Heart Inst J, 2017, 44(1): 29-38.
17.	Shi J, Wei L, Chen Y, et al. Transcatheter aortic valve implantation with J-valve: 2-Year outcomes from a multicenter study. Ann Thorac Surg, 2021, 111(5): 1530-1536.
18.	Isogai T, Saad AM, Ahuja KR, et al. Short-term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States. Catheter Cardiovasc Interv, 2021, 97(3): 477-485.
19.	Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
20.	Purita PAM, Tahoces LS, Fraccaro C, et al. Transcatheter treatment of native aortic valve regurgitation: Results from an international registry using the transfemoral ACURATE neo valve. Int J Cardiol Heart Vasc, 2020, 27: 100480.
21.	Liu L, Chen S, Shi J, et al. Transcatheter aortic valve replacement in aortic regurgitation. Ann Thorac Surg, 2020, 110(6): 1959-1965.
22.	Liu H, Liu S, Lu Y, et al. Transapical transcatheter aortic valve implantation for predominant aortic regurgitation with a self-expandable valve. J Thorac Dis, 2020, 12(3): 538-549.
23.	Arora S, Lahewala S, Zuzek Z, et al. Transcatheter aortic valve replacement in aortic regurgitation: The U. S. experience. Catheter Cardiovasc Interv, 2021, 98(1): E153-E162.
24.	Anwaruddin S, Desai ND, Szeto WY, et al. Self-expanding valve system for treatment of native aortic regurgitation by transcatheter aortic valve implantation (from the STS/ACC TVT Registry). Am J Cardiol, 2019, 124(5): 781-788.
25.	Zhu L, Guo Y, Wang W, et al. Transapical transcatheter aortic valve replacement with a novel transcatheter aortic valve replacement system in high-risk patients with severe aortic valve diseases. J Thorac Cardiovasc Surg, 2018, 155(2): 588-597.
26.	Tung M, Wang X, Li F, et al. A versatile transapical device for aortic valvular disease: One-year outcomes of a multicenter study on the J-Valve system. J Cardiol, 2018, 72(5): 377-384.
27.	Toggweiler S, Cerillo AG, Kim WK, et al. Transfemoral implantation of the acurate neo for the treatment of aortic regurgitation. J Invasive Cardiol, 2018, 30(9): 329-333.
28.	Silaschi M, Conradi L, Wendler O, et al. The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation. Catheter Cardiovasc Interv, 2018, 91(7): 1345-1351.
29.	Liu H, Yang Y, Wang W, et al. Transapical transcatheter aortic valve replacement for aortic regurgitation with a second-generation heart valve. J Thorac Cardiovasc Surg, 2018, 156(1): 106-116.
30.	De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
31.	Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
32.	Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: Results from an international registry study. JACC Cardiovasc Interv, 2017, 10(10): 1048-1056.
33.	Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: A preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
34.	Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
35.	Frerker C, Schewel J, Schewel D, et al. Expansion of the indication of transcatheter aortic valve implantation-feasibility and outcome in "off-label" patients compared with "on-label" patients. J Invasive Cardiol, 2015, 27(5): 229-236.
36.	Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: A multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
37.	Seiffert M, Bader R, Kappert U, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.
38.	Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol, 2013, 61(15): 1577-1584.
39.	罗一纯, 刘路路, 石峻, 等. 应用J-Valve瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果. 中国胸心血管外科临床杂志, 2019, 26(8): 737-743.
40.	许斌, 王艳超, 马骏. 经心尖主动脉瓣置换术治疗高危单纯无钙化主动脉瓣关闭不全的手术配合. 中华损伤与修复杂志(电子版), 2020, 15(6): 506-510.
41.	徐东辉, 罗新锦, 王旭, 等. 经股动脉经导管主动脉瓣置换术 (TAVR) 治疗单纯主动脉瓣关闭不全的临床疗效分析及术前评估. 中国胸心血管外科临床杂志, 2021, 28(9): 1054-1060.
42.	Markham R, Ghodsian M, Sharma R. TAVR in patients with pure aortic regurgitation: Ready to use? Curr Cardiol Rep, 2020, 22(9): 98.
43.	Siddique S, Vora A, Gada H. Transcatheter approaches to aortic insufficiency. Structural Heart, 2021, 5(1): 55-64.
44.	Ravalli F, Kossar AP, Takayama H, et al. Aortic valve regurgitation: Pathophysiology and implications for surgical intervention in the era of TAVR. Struct Heart, 2020, 4(2): 87-98.
45.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
46.	Webb JG, Htun N. Transcatheter options for the treatment of noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1850-1853.
47.	郭旭. 经导管主动脉瓣置换术及瓣膜的发展现状. 中国介入心脏病学杂志, 2021, 29(9): 523-526.
48.	Elhmidi Y, Bleiziffer S, Deutsch MA, et al. Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality. Arch Cardiovasc Dis, 2014, 107(2): 133-139.
49.	Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: Meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
50.	Erkapic D, De Rosa S, Kelava A, et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: A comprehensive analysis of the literature. J Cardiovasc Electrophysiol, 2012, 23(4): 391-397.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: First human case description. Circulation, 2002, 106(24): 3006-3008.
2. Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
3. 李忠城, 苏建, 李菊香. 经导管主动脉瓣置换术对于外科低危主动脉瓣狭窄患者有效性和安全性的Meta分析. 临床心血管病杂志, 2019, 35(9): 835-841.
4. 金力波, 吴昊, 冯卫中, 等. 不同路径行经导管主动脉瓣置换术安全性的系统评价与Meta分析. 中国胸心血管外科临床杂志, 2021, 28(7): 765-776.
5. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
6. 周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识 (2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
7. Virtanen MPO, Airaksinen J, Niemelä M, et al. Comparison of survival of transfemoral transcatheter aortic valve implantation versus surgical aortic valve replacement for aortic stenosis in low-risk patients without coronary artery disease. Am J Cardiol, 2020, 125(4): 589-596.
8. Asai T, Hosoba S, Suzuki T, et al. Postinfarction ventricular septal defect: Right ventricular approach-the extended "sandwich" patch. Semin Thorac Cardiovasc Surg, 2012, 24(1): 59-62.
9. Barik R. Transcatheter closure of post-myocardial infarction ventricular defect: Where are we? Indian Heart J, 2016, 68(1): 99-101.
10. Amrane H, Deeb GM, Popma JJ, et al. Causes of death in intermediate-risk patients: The randomized surgical replacement and transcatheter aortic valve implantation trial. J Thorac Cardiovasc Surg, 2019, 158(3): 718-728.
11. Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
12. Nadeau-Routhier C, Marsit O, Beaudoin J. Current management of patients with severe aortic regurgitation. Curr Treat Options Cardiovasc Med, 2017, 19(2): 9.
13. Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol, 1999, 83(6): 897-902.
14. Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation, 1999, 99(14): 1851-1857.
15. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: Why are so many denied surgery? Eur Heart J, 2005, 26(24): 2714-2720.
16. Arora S, Misenheimer JA, Ramaraj R. Transcatheter aortic valve replacement: Comprehensive review and present status. Tex Heart Inst J, 2017, 44(1): 29-38.
17. Shi J, Wei L, Chen Y, et al. Transcatheter aortic valve implantation with J-valve: 2-Year outcomes from a multicenter study. Ann Thorac Surg, 2021, 111(5): 1530-1536.
18. Isogai T, Saad AM, Ahuja KR, et al. Short-term outcomes of transcatheter aortic valve replacement for pure native aortic regurgitation in the United States. Catheter Cardiovasc Interv, 2021, 97(3): 477-485.
19. Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.
20. Purita PAM, Tahoces LS, Fraccaro C, et al. Transcatheter treatment of native aortic valve regurgitation: Results from an international registry using the transfemoral ACURATE neo valve. Int J Cardiol Heart Vasc, 2020, 27: 100480.
21. Liu L, Chen S, Shi J, et al. Transcatheter aortic valve replacement in aortic regurgitation. Ann Thorac Surg, 2020, 110(6): 1959-1965.
22. Liu H, Liu S, Lu Y, et al. Transapical transcatheter aortic valve implantation for predominant aortic regurgitation with a self-expandable valve. J Thorac Dis, 2020, 12(3): 538-549.
23. Arora S, Lahewala S, Zuzek Z, et al. Transcatheter aortic valve replacement in aortic regurgitation: The U. S. experience. Catheter Cardiovasc Interv, 2021, 98(1): E153-E162.
24. Anwaruddin S, Desai ND, Szeto WY, et al. Self-expanding valve system for treatment of native aortic regurgitation by transcatheter aortic valve implantation (from the STS/ACC TVT Registry). Am J Cardiol, 2019, 124(5): 781-788.
25. Zhu L, Guo Y, Wang W, et al. Transapical transcatheter aortic valve replacement with a novel transcatheter aortic valve replacement system in high-risk patients with severe aortic valve diseases. J Thorac Cardiovasc Surg, 2018, 155(2): 588-597.
26. Tung M, Wang X, Li F, et al. A versatile transapical device for aortic valvular disease: One-year outcomes of a multicenter study on the J-Valve system. J Cardiol, 2018, 72(5): 377-384.
27. Toggweiler S, Cerillo AG, Kim WK, et al. Transfemoral implantation of the acurate neo for the treatment of aortic regurgitation. J Invasive Cardiol, 2018, 30(9): 329-333.
28. Silaschi M, Conradi L, Wendler O, et al. The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation. Catheter Cardiovasc Interv, 2018, 91(7): 1345-1351.
29. Liu H, Yang Y, Wang W, et al. Transapical transcatheter aortic valve replacement for aortic regurgitation with a second-generation heart valve. J Thorac Cardiovasc Surg, 2018, 156(1): 106-116.
30. De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
31. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
32. Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: Results from an international registry study. JACC Cardiovasc Interv, 2017, 10(10): 1048-1056.
33. Zhu D, Chen Y, Zhang J, et al. Transapical implantation of a new second-generation transcatheter heart valve in patients with pure aortic regurgitation: A preliminary report. Interact Cardiovasc Thorac Surg, 2015, 20(6): 860-862.
34. Schofer J, Nietlispach F, Bijuklic K, et al. Transfemoral implantation of a fully repositionable and retrievable transcatheter valve for noncalcified pure aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1842-1849.
35. Frerker C, Schewel J, Schewel D, et al. Expansion of the indication of transcatheter aortic valve implantation-feasibility and outcome in "off-label" patients compared with "on-label" patients. J Invasive Cardiol, 2015, 27(5): 229-236.
36. Testa L, Latib A, Rossi ML, et al. CoreValve implantation for severe aortic regurgitation: A multicentre registry. EuroIntervention, 2014, 10(6): 739-745.
37. Seiffert M, Bader R, Kappert U, et al. Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv, 2014, 7(10): 1168-1174.
38. Roy DA, Schaefer U, Guetta V, et al. Transcatheter aortic valve implantation for pure severe native aortic valve regurgitation. J Am Coll Cardiol, 2013, 61(15): 1577-1584.
39. 罗一纯, 刘路路, 石峻, 等. 应用J-Valve瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果. 中国胸心血管外科临床杂志, 2019, 26(8): 737-743.
40. 许斌, 王艳超, 马骏. 经心尖主动脉瓣置换术治疗高危单纯无钙化主动脉瓣关闭不全的手术配合. 中华损伤与修复杂志(电子版), 2020, 15(6): 506-510.
41. 徐东辉, 罗新锦, 王旭, 等. 经股动脉经导管主动脉瓣置换术 (TAVR) 治疗单纯主动脉瓣关闭不全的临床疗效分析及术前评估. 中国胸心血管外科临床杂志, 2021, 28(9): 1054-1060.
42. Markham R, Ghodsian M, Sharma R. TAVR in patients with pure aortic regurgitation: Ready to use? Curr Cardiol Rep, 2020, 22(9): 98.
43. Siddique S, Vora A, Gada H. Transcatheter approaches to aortic insufficiency. Structural Heart, 2021, 5(1): 55-64.
44. Ravalli F, Kossar AP, Takayama H, et al. Aortic valve regurgitation: Pathophysiology and implications for surgical intervention in the era of TAVR. Struct Heart, 2020, 4(2): 87-98.
45. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
46. Webb JG, Htun N. Transcatheter options for the treatment of noncalcified aortic regurgitation. JACC Cardiovasc Interv, 2015, 8(14): 1850-1853.
47. 郭旭. 经导管主动脉瓣置换术及瓣膜的发展现状. 中国介入心脏病学杂志, 2021, 29(9): 523-526.
48. Elhmidi Y, Bleiziffer S, Deutsch MA, et al. Acute kidney injury after transcatheter aortic valve implantation: incidence, predictors and impact on mortality. Arch Cardiovasc Dis, 2014, 107(2): 133-139.
49. Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: Meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
50. Erkapic D, De Rosa S, Kelava A, et al. Risk for permanent pacemaker after transcatheter aortic valve implantation: A comprehensive analysis of the literature. J Cardiovasc Electrophysiol, 2012, 23(4): 391-397.

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Effectiveness and safety of transcatheter aortic valve replacement in treatment of aortic regurgitation: A systematic review and meta-analysis

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