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Abstract
BackgroundRecently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS.MethodsA systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows.ResultsAt one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [−0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR.ConclusionsDue to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.
Highlights
Transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS)
This growing trend is justified by multiple reasons including the remarkable technical advances in the valve replacement procedure which allows for easy repositioning and removal, the minimally invasive approach that permits performing under local anesthesia [5], as well as the fact that transcatheter aortic valve replacement (TAVR) is a common patient preference among surgically fit cases due to its shorter hospital stay, lower risk of bleeding and mild post-interventional symptoms [6]
Safety and efficacy outcomes All-cause mortality The overall risk ratios (RRs) did not favor either of the two groups in terms of in-hospital mortality (RR 1.11, 95% CI [0.63 to 1.95]), 30-day morality (RR 0.95, 95% CI [0.74 to 1.21]), 1-year mortality (RR 1.02, 95% CI [0.83 to 1.26]), or 2year mortality (RR 0.91, 95% CI [0.76 to 1.08]). These findings were consistent with another scenario in which we considered pooling of data from randomized controlled trials (RCTs) only
Summary
Transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). An epidemiological study estimated that more than one in eight individuals over the age of 75 years has a moderate to severe AS [2] Another meta-analysis revealed that the pooled prevalence of the disease among the elderly is 12.4% and estimated that there are more than 291,000 candidates for aortic valve replacement in North America and Europe [3]. Surgery is still considered the intervention of choice in operable cases of severe AS, transcatheter aortic valve replacement (TAVR) is continuously gaining ground in these lower risk groups [4]. Only four randomized controlled trials (RCTs) addressed this issue including the PARTNER-II, US pivotal, NOTION, and the prematurelyterminated STACATTO trial [8,9,10,11] Given this paucity of RCTs, observational studies are rendered a legitimate strategy to assess the comparative effectiveness of both procedures in operable patients [12]
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