Incidence and Predictors of Complications After Transcatheter Aortic Valve Implantation According to VARC-3 Criteria: A Systematic Review and Meta-Analysis.
Federico Giacobbe, Francesco Bruno, Marco Brero et al.
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In 30 seconds
This systematic review and meta-analysis pooled 57 studies involving 73 588 patients undergoing transcatheter aortic valve implantation (TAVI), with complications classified using VARC-3 criteria. Technical success was 95%, while all-cause mortality at an average 12 months of follow-up was 10.2%. Permanent pacemaker implantation was the most frequent reported complication (13%), followed by type 2 or greater bleeding (9.7%). Study-level analyses associated several complications, including acute kidney injury and bleeding, with higher mortality; these findings describe associations rather than causal effects.
Key findings
- Across 57 studies and 73 588 patients, technical success was 95% and 30-day device success was 90%.
- All-cause mortality at an average 12 months of follow-up was 10.2%.
- Permanent pacemaker implantation occurred in 13% and type 2 or greater bleeding in 9.7%.
- Study-level analyses associated acute kidney injury, bleeding, paravalvular regurgitation, non-structural valve dysfunction, and higher STS score with higher mortality.
Why it matters
The pooled estimates provide a broad picture of procedural success and complication burden when TAVI outcomes are classified using VARC-3 definitions. The associations between complications and mortality underscore the clinical importance of monitoring adverse events and interpreting procedural success alongside subsequent outcomes. Variation across the included studies may affect how directly pooled rates apply to individual settings.
What to keep in mind
The analysis pooled study-level data from multiple studies; predictor associations therefore do not establish causation or individual-level risk.