Heart and Vessels

, Volume 34, Issue 12, pp 1984–1992 | Cite as

Network meta-analysis of new-generation valves for transcatheter aortic valve implantation

  • Hisato TakagiEmail author
  • Yosuke Hari
  • Kouki Nakashima
  • Toshiki Kuno
  • Tomo Ando
  • ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
Original Article


To comprehensively compare and rank new-generation valves (NGVs) for transcatheter aortic valve implantation, we performed a network meta-analysis (NMA) of all eligible comparative studies. MEDLINE and EMBASE were searched through September 2018. We included all studies comparing 4 NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3) and an early generation valve (CoreValve) as the reference transcatheter heart valve (THV) each other and reporting at least one of postprocedural incidence of all-cause death, ≥ moderate aortic regurgitation (AR), and new permanent pacemaker implantation (PMI). To compare different THVs, a random-effects restricted-maximum-likelihood NMA based on a frequentist framework for indirect and mixed comparisons was used. Using surface under the cumulative ranking curve (SUCRA), the relative ranking probability of each THV was estimated and the hierarchy of competing THVs was obtained. We identified 29 eligible studies enrolling a total of 17,817 patients. In accordance with the estimated SUCRA probability, SAPIEN 3 was the best effective for a reduction in death (80.6%) and the second best for decreased ≥ moderate AR (74.4%) and PMI (74.1%) compared with the other THVs. Lotus was ranked the best for a reduction in ≥ moderate AR (94.5%;), whereas the worst for decreased PMI (1.2%) and the second worst for a reduction in mortality (38.6%). ACURATE was the best for decreased PMI (99.2%) and the second best for a reduction in mortality (77.9%). As a whole, SAPIEN 3 may be the best effective NGV among the 4 examined NGVs (ACURATE, Evolut R, Lotus, and SAPIEN 3).


Network meta-analysis New-generation transcatheter heart valve Transcatheter aortic valve implantation 


Compliance with ethical standards

Conflict of interest

None of the authors declare any potential conflict of interest.

Research involving human participants and/or animals

The present study is a meta-analysis of published articles, and neither a human nor animal study that should be approved by the appropriate ethics committee and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

The present study is a meta-analysis of published articles, and accordingly, there are no persons who gave their informed consent prior to their inclusion in the study.

Supplementary material

380_2019_1442_MOESM1_ESM.pdf (338 kb)
Supplementary file1 (PDF 338 kb)
380_2019_1442_MOESM2_ESM.pdf (361 kb)
Supplementary file2 (PDF 360 kb)
380_2019_1442_MOESM3_ESM.pdf (116 kb)
Supplementary file3 (PDF 116 kb)


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Hisato Takagi
    • 1
    • 2
    Email author
  • Yosuke Hari
    • 1
    • 2
  • Kouki Nakashima
    • 1
    • 2
  • Toshiki Kuno
    • 3
  • Tomo Ando
    • 4
  • ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
  1. 1.Department of Cardiovascular SurgeryShizuoka Medical CenterShizuokaJapan
  2. 2.Department of Cardiovascular SurgeryKitasato University School of MedicineSagamiharaJapan
  3. 3.Department of MedicineNew YorkUSA
  4. 4.Department of CardiologyDetroit Medical CenterDetroitUSA

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