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Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: A meta‐analysis of randomized trials and propensity score matched observational studies
Author(s) -
Witberg Guy,
Lador Adi,
Yahav Dafna,
Kornowski Ran
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.27518
Subject(s) - medicine , aortic valve replacement , valve replacement , propensity score matching , randomized controlled trial , relative risk , surgery , stenosis , observational study , stroke (engine) , population , myocardial infarction , aortic valve stenosis , cardiology , confidence interval , mechanical engineering , environmental health , engineering
Background Although transcatheter aortic valve replacement (TAVR) is officially indicated for high risk aortic stenosis (AS) patients, the procedure is increasingly being performed in patients who are not at high surgical risk, including a substantial number of low risk patients. However, data on the benefit of TAVR in this patient population is limited. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) of TAVR versus surgical aortic valve replacement (SAVR) in patients who are at low surgical risk. The primary outcome was all‐cause mortality. The secondary outcomes included stroke, myocardial infarction, bleeding, and various procedural complications. Results Six studies (2 RCTs and 4 PSM studies) totaling 3,484 patients were included. Follow‐up ranged from 3 months to 3 years (median 2 years). The short‐term mortality was similar with either TAVR or SAVR (2.2% for TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56–1.41, P = 0.62), however, TAVR was associated with increased risk for intermediate‐term mortality (17.2% for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11–1.89, P = 0.006). In terms of periprocedural complications, TAVR was associated with reduced risk for bleeding and renal failure and an increase in vascular complications and Pacemaker implantation. Conclusions In patients who are at low surgical risk, TAVR seems to be associated with increased mortality risk. Until more data in this population is available, SAVR should remain the treatment of choice for these patients.