Abstract
BackgroundThe current treatment for aortic stenosis includes open surgical aortic valve replacement (SAVR) as well as endovascular transcatheter aortic valve replacement (TAVR). This study aims to compare the 1-year, 2–3 year and 5-year structural durability of TAVR valves with that of SAVR valves.MethodA systematic literature search was conducted in July 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the PRISMA guidelines.ResultsThirteen randomized controlled trials were included. From the meta-analysis, we observed higher rates of 1-year (OR: 7.65, CI: 4.57 to 12.79, p < 0.00001), 2–3-year (OR: 13.49, CI: 5.66 to 32.16, p < 0.00001) and 5-year paravalvular regurgitation (OR: 14.51, CI: 4.47 to 47.09, p < 0.00001) associated with the TAVR valves than the SAVR valves. There were also higher rates of 1-year (OR: 5.00, CI: 3.27 to 7.67, p < 0.00001), 2–3-year (OR: 8.14, CI: 3.58 to 18.50, p < 0.00001) and 5-year moderate or severe aortic regurgitation (MD: 14.65, CI: 4.55 to 47.19, p < 0.00001), and higher rates of 1-year (OR: 3.55, CI: 1.86 to 6.77, p = 0.0001), 2–3-year (OR: 3.55, CI: 1.86 to 6.77, p = 0.0001) and 5-year reintervention (OR: 3.55, CI: 1.22 to 10.38, p = 0.02) in the TAVR valves as compared to SAVR valves.ConclusionTAVR valves appear to be more susceptible to structural valve deterioration and thus potentially less structurally durable than SAVR valves, given that they may be associated with higher rates of moderate or severe aortic regurgitation, paravalvular regurgitation and reintervention in the 1-year-, 2–3 year, and 5-year period.
Highlights
Aortic stenosis is currently the most common valvular disease in developed countries, with an overall prevalence of approximately 1–3% in European patients who are more than 70 years old [1]
transcatheter aortic valve replacement (TAVR) valves appear to be more susceptible to structural valve deterioration and potentially less structurally durable than surgical aortic valve replacement (SAVR) valves, given that they may be associated with higher rates of moderate or severe aortic regurgitation, paravalvular regurgitation and reintervention in the 1-year, 2–3 year, and 5-year period
All other studies were at unclear risk of performance bias as not enough information was available for a conclusion to be made. Another 3 studies were prone to high risk of attrition bias due to insufficient details provided on missing data [17, 19, 21] (Fig. E1 and E2)
Summary
Aortic stenosis is currently the most common valvular disease in developed countries, with an overall prevalence of approximately 1–3% in European patients who are more than 70 years old [1]. The current methods for treatment for the disease include Surgical Aortic Valve Replacement (SAVR) and the less-invasive Transcatheter Aortic Valve Replacement (TAVR) technique. The use of this technique has been extended to low-and intermediate-risk patients as well [3], with more studies evaluating the safety and efficacy of this minimally invasive procedure in these differing patient cohorts. Both SAVR and TAVR use bioprosthetic valves, with the SAVR valve being a fixed stent with an estimated life span of 15 years and the TAVR valve being capable of expanding and collapsing [4]. This study aims to compare the 1-year, 2–3 year and 5-year structural durability of TAVR valves with that of SAVR valves
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