Dedicated Versus Conventional Devices in Patients With Pure Native Aortic Regurgitation: A Systematic Review and Meta‐Analysis
Bibliographic record
Abstract
Background Surgical aortic valve replacement is the gold standard for treating pure native aortic regurgitation. However, many patients have unacceptable surgical risk. Increasing evidence supports the use of transcatheter aortic valve replacement in this subset. This metanalysis aims to evaluate transcatheter aortic valve replacement efficacy in pure native aortic regurgitation. Methods We systematically searched MEDLINE/PubMed, Embase, the Cochrane Database, Google Scholar, ClinicalTrials.gov , and major cardiology conference abstracts from inception to April 1, 2024, and included 19 observational studies with ≥20 patients with pure native aortic regurgitation undergoing transcatheter aortic valve replacement. The primary end point was 30‐day all‐cause mortality; secondary end points were device success, valve migration, and 1‐year all‐cause mortality. Pooled estimates were calculated using random‐effects meta‐analysis. Risk of bias was assessed using the Newcastle–Ottawa Scale and publication bias with funnel plots and Egger’s test. The study protocol was registered in International Prospective Register of Systematic Reviews (CRD42024534117). Results The pooled 30‐day mortality was 8.7% (95% CI, 5.8%–10.7%), and decreased from first (16.9% [95% CI, 13.2%–18.9%]) to second generation (7.2% [95% CI, 6.1%–9.2%]) and dedicated devices (4.7% [95% CI, 1.8%–8.9%; P <0.0001]). Overall device success was 84.1% (95% CI, 78.0%–88.9%), improving from first (63.1% [95% CI, 52.0%–72.5%]) to second generation (86.3% [95% CI, 80.1%–90.4%]) and dedicated devices (93.0% [95% CI, 86.2%–97.3%]; P <0.00001). Valve migration occurred in 7.8% (95% CI, 5.0%–11.7%) of cases, decreasing from first (19.0% [95% CI, 15.2%–24.7%]) to second generation (6.9% [95% CI, 3.7%–10.0%]) and dedicated devices (3.0% [95% CI, 1.3%–5.6%]; P <0.00001). Overall 1‐year mortality was 14.0% (95% CI, 10.1%–19.9%) and decreased from first (27.2% [95% CI, 15.4%–43.2%]) to second generation (12.7% [95% CI, 8.8%–18.9%]) and dedicated devices (8.7% [95% CI, 3.5%–16.7%]; P <0.0001). Conclusions Although the observational design, lack of patient‐level data, device heterogeneity, and potential publication bias limit definitive conclusions, transcatheter aortic valve replacement using dedicated devices may be considered a safe and effective therapeutic option for patients with pure native aortic regurgitation and unacceptable risk for surgery. Registration URL: https://www.crd.york.ac.uk/prospero/ ; Unique identifier: CRD42024534117.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.020 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.037 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".