Premium
Transcatheter versus surgical aortic valve replacement in intermediate‐risk patients: Evidence from a meta‐analysis
Author(s) -
Sardar Partha,
Kundu Amartya,
Chatterjee Saurav,
Feldman Dmitriy N.,
Owan Theophilus,
Kakouros Nikolaos,
Nairooz Ramez,
Pape Linda A.,
Feldman Ted,
Dawn Abbott J.,
Elmariah Sammy
Publication year - 2017
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27041
Subject(s) - medicine , number needed to harm , valve replacement , cardiology , relative risk , aortic valve replacement , hazard ratio , atrial fibrillation , confidence interval , stroke (engine) , number needed to treat , stenosis , aortic valve stenosis , myocardial infarction , aortic valve , surgery , mechanical engineering , engineering
Objectives We performed a meta‐analysis to evaluate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR) in intermediate‐risk patients. Background TAVR is an established treatment option in high‐risk patients with severe aortic valve stenosis (AS). There are fewer data regarding efficacy of TAVR in intermediate‐risk patients. Methods Databases were searched through April 30, 2016 for studies that compared TAVR with SAVR for the treatment of intermediate‐risk patients with severe AS. We calculated summary risk ratios (RRs) and 95% confidence intervals (CIs) with the random‐effects model. Results The analysis included 4,601 patients from 7 studies (2 randomized and 5 observational). There was no significant difference in all‐cause mortality between the two groups after mean follow‐up of 1.15 years [14.7% with TAVR vs 15.4% with SAVR; RR 0.93; 95% CI 0.77–1.12]. TAVR resulted in lower rates of acute kidney injury [number needed to treat (NNT) = 26], major bleeding (NNT = 4), and atrial‐fibrillation (NNT = 6), but higher rates of major vascular complications [number needed to harm (NNH)= 18], and moderate/severe aortic regurgitation (NNH = 13). The rate of permanent‐pacemaker implantation was significantly higher with TAVR in observational studies (RR 2.31; 95% CI 1.22–2.81), but not in RCTs (RR 1.21; 95% CI 0.93–1.56). No significant difference in the rate of stroke or myocardial infarction was observed. Conclusions Our analysis of mid‐term results showed that TAVR has similar clinical efficacy to SAVR in intermediate‐risk patients with severe AS, and can be a suitable alternative to surgical valve replacement. © 2017 Wiley Periodicals, Inc.