{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:26:47Z","timestamp":1793824007653,"version":"4.6.1"},"reference-count":49,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"unspecified","delay-in-days":108,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"2024 Yat-sen Postdoctoral Startup Program","award":["2024 Yat-sen Postdoctoral Startup Program"],"award-info":[{"award-number":["2024 Yat-sen Postdoctoral Startup Program"]}]},{"DOI":"10.13039\/501100020084","name":"Guangzhou Municipal Science and Technology Bureau","doi-asserted-by":"publisher","award":["202206080014"],"award-info":[{"award-number":["202206080014"]}],"id":[{"id":"10.13039\/501100020084","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,9,2]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for aortic regurgitation (AR) in patients at high surgical risk. However, evidence comparing outcomes of different new-generation devices remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare clinical outcomes of on-label, off-label self-expanding (SE) and off-label balloon-expandable (BE) TAVR devices in AR patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted, including studies reporting clinical outcomes of new-generation TAVR devices in AR. The primary outcome was 1-year all-cause mortality. Secondary outcomes included procedural success, moderate or severe AR and perioperative complications. Subgroup and meta-regression analyses assessed the impact of valve type and clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>32 studies involving 2682 patients were included. 1-year mortality was 10.4% (95% CI: 7.2% to 14.7%) with no significant difference among valve types. Technical success was highest with on-label devices (97%), followed by off-label:BE (92%) and off-label:SE (85%) (p&lt;0.001). Valve migration occurred in 2% of on-label, 7% of off-label:BE and 10% of off-label:SE cases (p=0.004). Moderate or severe AR was observed in 2% of on-label, 4% of off-label:BE and 8% of off-label:SE recipients (p&lt;0.001). Meta-regression identified coronary heart disease as an independent predictor of 1 year mortality (p=0.026), while other factors showed no significant association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>On-label devices were associated with improved procedural outcomes, including lower rates of valve migration and residual AR, although 1-year mortality did not differ significantly between device groups. Further prospective studies with longer follow-up are needed to assess valve durability and long-term clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD 42024611296.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003482","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:20:29Z","timestamp":1760700029000},"page":"e003482","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative outcomes of on-label and off-label transcatheter aortic valve replacement for aortic regurgitation: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2504-1637","authenticated-orcid":false,"given":"Yanren","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqing","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zizhuo","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruqiong","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"2026010701111042000_12.2.e003482.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041080"},{"key":"2026010701111042000_12.2.e003482.2","first-page":"101228","article-title":"Mortality Burden for Patients With Untreated Aortic Regurgitation","volume":"3","author":"G\u00e9n\u00e9reux","year":"2024","journal-title":"JACC: Advances"},{"key":"2026010701111042000_12.2.e003482.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.14.1851"},{"key":"2026010701111042000_12.2.e003482.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2007.10.008"},{"key":"2026010701111042000_12.2.e003482.5","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.jacasi.2021.11.013","article-title":"Distribution, Characteristics, and Management of Older Patients With Valvular Heart Disease in China: China-DVD Study","volume":"2","author":"Xu","year":"2022","journal-title":"JACC Asia"},{"key":"2026010701111042000_12.2.e003482.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00201-X"},{"key":"2026010701111042000_12.2.e003482.7","doi-asserted-by":"crossref","unstructured":"Baumbach A , Patel KP , Rudolph TK , et al . n.d. 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