Permanent pacemaker implantation following transcatheter aortic valve implantation: a systematic review and Bayesian network meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Permanent pacemaker implantation (PPI) remains a common complication after transcatheter aortic valve (TAVI). Different heart valves (THVs) exist, and newly approved devices are growing. A comparison according to the mechanisms TAVI prosthesis with longer follow-up needs be made. We address this issue using systematic review Bayesian network meta-analysis (NMA). Methods literature was carried out up Oct 31, 2022, identify studies reporting use balloon-expandable (BEVs), self-expandable (SEVs), mechanically expandable (MEVs). compared various THVs, or standard medical treatment (STD), comparator surgical replacement (SAVR) concerning PPI. Data at most extended for each study were extracted. random-effects NMA used calculate odds ratios (OR) 95% credible intervals (CrI) MetInsight V4.0.0. The surface under cumulative ranking area (SUCRA) probabilities selected hierarchy different treatments. larger SUCRA indicates greater likelihood becoming best intervention. Results included 15 RCTs comprising 12.783 patients, among whom 8.585 underwent commercially available including BEVs (Sapien & Sapien XT, 3), MEVs (Corevalve, Evolut Pro/R, Acurate Neo, Portico), (Lotus). median 2.5 years (IQR 1-5). No significant differences in risk PPI observed between STD: 1.70 [0.556, 5.39], XT: 1.39 [0.834, 2.41], 3: [0.977, 2.88], Neo: 1.68 [0.768, 3.789], SARV. All other THVs (Corevalve: 3.07 [1.99. 4.959]; Pro/R: 3.19 [1.80, 6.03]; Lotus: 5.22 [2.08, 13.7]; Portico: 7.22 [2.85, 19.4]) showed In results, XT had highest chance (77%) providing lower rate. Meanwhile, Portico THV ranked worst (5%) regarding rate (Figure 1). According mechanism, all higher than SARV (BEVs: 1.60 [1.01, 2.54]; SEVs: 3.09 [1.97, 4.96]; MEV: 5.30 [1.62, 17.7]). 1.92 [0.518, 7.14] non-significant plot that intervention lowest (95%) probability PPI, followed by (65%), STD (55%), SEVs (27%) (7%) 2). both analyses, assessment inconsistency direct indirect estimates not (P > 0.05). Conclusions This includes more number patients follow-up. demonstrated associated rates MEVs. Some newer generations (Acurate R/Pro) performed better older ones, reducing