Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Cardiac Surgery: Meta-Analysis and Systematic Review of the Literature.

Azka Latif,Vikas Kapoor,Rana Mohammad Usman,Mohsin Mirza,Stephen Cooper,Muhammad Zubair Ashfaq,Venkata Andukuri,Rami Khouzam,Muhammad Junaid Ahsan,Noman Lateef

doi:10.3390/jcdd7030036

Abstract

The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1–2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1–2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.

Highlights

In the United States, degenerative aortic valve disease is the third most common cardiovascular disease affecting approximately 2.5 million adults [1,2]
This study aimed to evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing Transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS)
Data were extracted on a pre-specified table (Table 1), which included the following parameters: 30-day mortality, 1–2-year mortality, post-operative stroke, major bleeding, mean length of hospital stay, discharge to home from the hospital, post-operative acute renal failure, and pacemaker implantation

Summary

Introduction

In the United States, degenerative aortic valve disease is the third most common cardiovascular disease affecting approximately 2.5 million adults [1,2]. Transcatheter aortic valve replacement (TAVR) is superior to medical management in patients with severe symptomatic AS in whom surgical aortic valve replacement (SAVR) is associated with a prohibitive risk [3]. An increasing number of patients with severe AS have a history of prior cardiac surgery which is associated with increased risk of undergoing aortic valve replacement. In such cases, the proposed benefit of TAVR versus SAVR remains unknown.

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