Author + information
- 1Saint Peter's University Hospital, New Brunswick, NJ, New Brunswick, New Jersey, United States
- 2SUNY Downstate Medical Center, Brooklyn, New York, United States
- 3St Luke’s University Hospital, Bethlehem, PA, USA
- 4Albert Einstein College of Medicine, Bronx, NY, USA
- 5Unknown, New Brunswick, New Jersey, United States
- 6RWJ Univ Hospital, Somerset, New Jersey, United States
Transcatheter Aortic Valve Replacement (TAVR) has shown comparable results to surgical valve replacement (SVR) in patients with severe aortic stenosis (AS) who are at high risk for surgery. We conducted a meta-analysis to evaluate the safety and efficacy of TAVR versus SVR in low-intermediate risk patients.
A systematic review was conducted of randomized control trials (RCTs) and observational studies comparing TAVR versus SVR in low-intermediate risk patients included in MEDLINE, EMBASE, CINAHL and Cochrane databases. The outcomes of interest were all-cause mortality, cardiovascular mortality (CVM), myocardial infarction (MI), stroke, major bleeding, acute kidney injury (AKI), new atrial fibrillation, major vascular complications, moderate-severe para-valvular regurgitation (PVR) and new permanent pacemaker (PPM) implantation. Pooled analyses were performed using random-effects model and treatment effects were reported as risk ratios (RR) with 95% confidence intervals (CI).
Ten studies comprising three RCTs and seven observational studies, with a total of 5,346 patients were included. There were no significant differences between TAVR and SVR in terms of mortality [RR 0.90; 95% CI 0.69-1.18, RR 1.02; 95% CI 0.89-1.17], CVM [RR 0.89; 95% CI 0.50-1.59, RR 0.90; 95% CI 0.70-1.15], stroke [RR 0.88; 95% CI 0.65-1.20, RR 1.09; 95% CI 0.86-1.38] at 30 days or medium-long term follow up respectively, and major bleeds [RR 0.57, 95% CI 0.27-1.20]. TAVR was associated with significantly lower rates of 30 days MI [RR 0.52, 95% CI 0.31-0.87], AKI [RR 0.46, 95% CI 0.32-0.65] and new atrial fibrillation [RR 0.33, 95% CI 0.27-0.40]. On the contrary, the risks of major vascular complication [RR 8.02, 95% CI 2.31-27.86], new PPM implantation [RR 3.74, 95% CI 1.92-7.28] and moderate-severe PVR [RR 5.77, 95% CI 3.59-9.27] were significantly increased with TAVR. On sub-analysis, higher rates of major vascular complication and new PPM implantation reached statistical significance for only the self-expanding but not the balloon-expandable TAVR prosthesis.
TAVR is an acceptable option for low-intermediate risk patients with severe AS with similar risk of mortality compared to SVR.
STRUCTURAL: Valvular Disease: Aortic