Transcatheter versus surgical aortic valve replacement in low- and intermediate-risk patients: an updated systematic review and meta-analysis

Transcatheter versus surgical aortic valve replacement in low- and intermediate-risk patients: an updated systematic review and meta-analysis

Transcatheter aortic valve replacement (TAVR) has been recognized as a well-established alternative to surgical aortic valve replacement (SAVR) for symptomatic aortic stenosis with high surgical risk. With this updated systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low- and inter...

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Veröffentlicht in:Cardiovascular intervention and therapeutics 2019-07, Vol.34 (3), p.216-225
Hauptverfasser: Ueshima, Daisuke, Fovino, Luca Nai, D’Amico, Gianpiero, Brener, Sorin J., Esposito, Giovanni, Tarantini, Giuseppe
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Cardiology
Interventional Radiology
Medicine
Medicine & Public Health
Original Article
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container_end_page 225
container_issue 3
container_start_page 216
container_title Cardiovascular intervention and therapeutics
container_volume 34
creator Ueshima, Daisuke
Fovino, Luca Nai
D’Amico, Gianpiero
Brener, Sorin J.
Esposito, Giovanni
Tarantini, Giuseppe
description Transcatheter aortic valve replacement (TAVR) has been recognized as a well-established alternative to surgical aortic valve replacement (SAVR) for symptomatic aortic stenosis with high surgical risk. With this updated systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low- and intermediate-risk subjects. Studies comparing TAVR and SAVR in low-risk patients (defined as STS ≤ 8% or EuroSCORE ≤ 20%) were identified with electronic searches. The principal endpoint was all-cause mortality at short term (
doi_str_mv 10.1007/s12928-018-0546-5
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With this updated systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low- and intermediate-risk subjects. Studies comparing TAVR and SAVR in low-risk patients (defined as STS ≤ 8% or EuroSCORE ≤ 20%) were identified with electronic searches. The principal endpoint was all-cause mortality at short term (&lt; 3 months), 1, and 2 years. Other outcomes of interest were cardiac mortality, neurological events, paravalvular leakage (PVL), myocardial infarction (MI), major bleeding, acute kidney injury (AKI), vascular complications, and new pacemaker (PM) implantation. Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were eligible. There was no significant difference in all-cause mortality at short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63–1.09], 1 year (OR 1.01, 95% CI 0.86–1.20) and 2 years (OR 0.86, 95% CI 0.64–1.16) between treatment groups. Subgroup analyses stratified by surgical risk score (low-risk subgroup: STS &lt; 4% or EuroSCORE &lt; 10%, intermediate-risk subgroup: the others) did not show interaction on primary endpoints. Compared to SAVR, TAVR had similar rates of neurological events, significantly lower risk of MI and AKI, but higher risk of vascular complications, new PM implantation and moderate/severe PVL. In low- and intermediate-risk patients, TAVR and SAVR have similar short- and mid-term all-cause mortality. 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subjects Cardiology
Interventional Radiology
Medicine
Medicine & Public Health
Original Article
title Transcatheter versus surgical aortic valve replacement in low- and intermediate-risk patients: an updated systematic review and meta-analysis
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