DOI: 10.1161/jaha.125.048377 ISSN: 2047-9980

Outcomes of Transcatheter Aortic Valve Replacement in the Middle East and North Africa: A Systematic Review and Meta‐Analysis

Mohammad‐Mahdi Bastan, Sahand Siami, Fatemeh Jodeiri, Sina Kazemian, Mandana Ebrahimzade, Niloofar Seighali, Saba Maleki, Nazanin Anaraki, Magdy Abdelhamid, Saif‐El‐Dean Abdel‐Rahman, Kaveh Hosseini
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Background

Data on transcatheter aortic valve replacement (TAVR) outcomes in the Middle East and North Africa region are limited. We synthesized available evidence on post‐TAVR clinical outcomes in the Middle East and North Africa region.

Methods

We systematically searched PubMed, Embase, and Scopus from inception through May 2025 for studies reporting TAVR outcomes in this region. Outcomes included device success, all‐cause death, cardiovascular death, myocardial infarction, stroke, new‐onset atrial fibrillation, moderate to severe paravalvular leak, and permanent pacemaker implantation. Overall incidence rates were pooled via Poisson analysis and reported per 100 person‐years with 95% CIs.

Results

Forty‐eight studies encompassing 7331 patients (mean age, 76.9±8.5 years; 52.4% women) were included. Pooled device success rate was 96.4% (95% CI, 95.8%–97.0%). At latest follow‐up, pooled incidence rates per 100 person‐years were 13.7 for all‐cause death (95% CI, 12.9–14.6), 4.8 for cardiovascular death (95% CI, 4.1–5.7), 1.0 for myocardial infarction (95% CI, 0.7–1.4), 1.6 for stroke (95% CI, 1.3–1.9), 2.7 for moderate to severe paravalvular leak (95% CI, 2.2–3.4), 6.5 for new‐onset atrial fibrillation (95% CI, 5.5–7.7), and 10.0 for permanent pacemaker implantation (95% CI, 9.2–10.9). Post hoc exploratory meta‐regression identified significant study‐level modifying effects, with higher mean age and greater use of first‐generation versus second‐generation valves associated with higher overall all‐cause mortality incidence following TAVR. Certainty of evidence was low or very low across all outcomes.

Conclusions

TAVR in the Middle East and North Africa region was associated with high device success rate and relatively low cardiovascular death. Permanent pacemaker implantation was the most prevalent post‐TAVR complication. Further studies are warranted to optimize TAVR practice in this region.

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