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Meta‐analysis of transfemoral TAVR versus surgical aortic valve replacement
Author(s) -
Arora Sameer,
Vaidya Satyanarayana R.,
Strassle Paula D.,
Misenheimer Jacob A.,
Rhodes Jeremy A.,
Ramm Cassandra J.,
Wheeler Evan N.,
Caranasos Thomas G.,
Cavender Matthew A.,
Vavalle John P.
Publication year - 2018
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.27357
Subject(s) - medicine , relative risk , atrial fibrillation , aortic valve replacement , valve replacement , myocardial infarction , cardiology , propensity score matching , lower risk , cohort , cohort study , surgery , randomized controlled trial , meta analysis , confidence interval , stenosis
Background In the recently concluded PARTNER 2 trial, TF‐TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. Methods We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity‐score‐matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF‐TAVR patients were eligible for inclusion. Outcomes of interest included 30‐day and 1‐year mortality, and 30‐day complications. If significant heterogeneity was found in the random effects meta‐analyses, a sensitivity analysis which individually removed each study was conducted. Results Seven studies reported results on TF‐TAVR. Compared with SAVR, TF‐TAVR had comparable 30‐day mortality (RR 0.79, 95% CI 0.58, 1.06), 1‐year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30‐day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF‐TAVR was associated with lower 30‐day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions TF‐TAVR is associated with lower 30‐day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF‐TAVR outcomes.