Abstract
Background: Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. Methods: We performed a systematic review and meta-analysis of all published studies with ≥5years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. Results: The meta- analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male). All TAVR procedures were performed with early generations of THV. At a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33; 95% CI: [1.78, 6.24], p 2 = 0%), all-cause mortality (OR 1.45; 95% CI: [1.22, 1.75], p 2 = 44%) and the composite of reintervention and death (OR 1.47; 95% CI: [1.14, 1.91], p 2 = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. Conclusion: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.
Highlights
In patients with severe aortic stenosis and prohibitive or high surgical risk for aortic valve replacement (SAVR), multiple trials have shown that transcatheter aortic valve replacement (TAVR) is non-inferior to SAVR [1] [2]
The expanding indications for TAVR to include lower-risk patients with longer life-expectancy highlight the importance of the long-term durability of transcatheter valves (THV)
We analysed a total of 4 RCTs and one propensity-matched observational trial, including 2101 TAVR patients and 2044 SAVR patients
Summary
In patients with severe aortic stenosis and prohibitive or high surgical risk for aortic valve replacement (SAVR), multiple trials have shown that transcatheter aortic valve replacement (TAVR) is non-inferior to SAVR [1] [2]. We performed a systematic review and meta-analysis of all studies comparing TAVR to SAVR with a minimum of five years of follow-up to determine the comparative rates of reintervention and death. Methods: We performed a systematic review and meta-analysis of all published studies with ≥5 years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Conclusion: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes
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