Midterm outcome of transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized controlled trials

Abstract

BackgroundCurrent guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk. MethodsPubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up. Clinical endpoints including death, acute kidney injury, myocardial infarction, stroke, permanent pacemaker implantation, and life-threatening bleeding events were assessed. ResultsFrom 2000 to 2017, 4 clinical studies comprising 4355 patients were identified. At 2-year follow-up, TAVR was associated with similar rate of death from any cause (RR 0.86; 95%CI: 0.67–1.10), cardiovascular death (RR 0.88; 95%CI: 0.73–1.06), and stroke (RR 0.97; 95%CI: 0.81–1.15). TAVR reduced incidence of bleeding events (RR 0.45; 95%CI: 0.28–0.73) and acute kidney injury (RR 0.48; 95%CI: 0.25–0.93). However, TAVR was associated with higher rate of permanent pacemaker implantation (RR 3.01; 95%CI: 1.04–8.72). ConclusionIn patients at low to intermediate surgical risk, midterm clinical outcomes of TAVR were similar to SAVR in survival and stroke rate, superior in reducing life-threatening bleeding, acute kidney injury, and new-onset atrial fibrillation, but inferior in increasing permanent pacemaker implantation.