Incidence and Predictors of Complications After Transcatheter Aortic Valve Implantation According to VARC-3 Criteria: A Systematic Review and Meta-Analysis.
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Giacobbe Federico, Bruno Francesco, Brero Marco, Meynet Pierre, Solano Andrea, Capoccia Sergio, Pilia Riccardo, D'Ascenzo Fabrizio, Conrotto Federico, Tarantini Giuseppe, la Torre Michele, Kim Won-Keun, Buono Andrea, Blumenstein Johannes, Polzin Amin, Gennari Marco, Gmeiner Jonas M D, Piperata Antonio, Ruge Hendrik, Li Jie, Mascherbauer Julia, Waksman Ron, Barbash Israel, Tang Gilbert, Gasior Tomasz, Webb John, Hioki Hirofumi, Obaid Daniel, Mangieri Antonio, Crimi Gabriele, Joner Michael, Toggweiler Stefan, Mauri Victor, Lin Mao-Shin, Haussig Stephan, Avvedimento Marisa, Nanayakkara Shane, Serruys Patrick W, Landolff Quentin, Latib Azeem, Rodes-Cabau Josep, De Ferrari Gaetano Maria, de Filippo Ovidio
Аннотация
METHODS: We conducted a systematic review and meta-analysis of studies reporting transcatheter aortic valve implantation-related complications using VARC-3 definitions between 2021 and 2025. The primary end point was all-cause mortality at latest follow-up. Secondary end points included major VARC-3 complications and predictors of adverse events.
RESULTS: A total of 57 studies with 73 588 patients were included. The cohort had a mean age of 81.7 years, 51.7% were women, and most had preserved ejection fraction (55.5%) and low-to-moderate surgical risk (Society of Thoracic Surgeons [STS] predicted risk of mortality [PROM] 4.1%). Technical and 30-day device success rates were 95% and 90%, respectively; early safety rate at 30 days was 66%. At average 12 months follow-up, all-cause mortality was 10.2%. The most common complication was permanent pacemaker implantation (13%), followed by type 2 or greater bleeding (9.7%), acute kidney injury stage 3-4 (4.7%), major vascular events (4.3%), and stroke (3.0%). Moderate/severe paravalvular regurgitation and patient-prosthesis mismatch occurred in 4% and 8%, respectively. Study-level pooled predictor analyses showed that acute kidney injury, type 2 or greater bleeding, paravalvular regurgitation, non-structural valve dysfunction, and higher STS score were associated with higher mortality, while eccentric/severe aortic valve calcification was associated with significant paravalvular regurgitation.
CONCLUSIONS: Transcatheter aortic valve implantation shows high procedural success but non-negligible complication rates under VARC-3 criteria. acute kidney injury, type 2 or greater bleeding, NSVD, periprocedural stroke and myocardial infarction after transcatheter aortic valve implantation were associated with higher mortality.