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Transcatheter aortic valve replacement versus surgical aortic valve replacement in low‐surgical‐risk patients: An updated meta‐analysis
Author(s) -
Goel Sunny,
Pasam Ravi T.,
Wats Karan,
Patel Jignesh,
Chava Srilekha,
Gotesman Joseph,
Malik Bilal A.,
Frankel Robert,
Shani Jacob,
Gidwani Umesh
Publication year - 2020
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.28520
Subject(s) - medicine , aortic valve replacement , odds ratio , valve replacement , stroke (engine) , cardiology , stenosis , euroscore , aortic valve stenosis , surgery , aortic valve , cardiac surgery , mortality rate , mechanical engineering , engineering
Objective The purpose of this meta‐analysis is to compare the safety and efficacy of transcatheter aortic‐valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in low‐surgical‐risk patients. Background TAVR is proven to be safe and effective in patients with high‐ and intermediate‐risk aortic stenosis. However, there is limited data on the safety and efficacy of TAVR in patients with low surgical risk. Methods We conducted an electronic database search of all published data for studies that compared TAVR to SAVR in low‐surgical‐risk patients (mean society for thoracic surgery [STS] score <4% and/or logistic EuroScore <10%) and reported on subsequent all‐cause mortality, cardiac mortality, stroke rates, and other outcomes of interest. Event rates were compared with a forest plot of odds ratio using a random‐effects model assuming interstudy heterogeneity. Results A total of seven studies ( n = 6,293 patients; TAVR = 2,912; and SAVR = 3,381) were included in the final analysis. There was no significant difference between TAVR and SAVR in terms of all‐cause mortality (OR 0.82; 95% CI 0.50–1.36, I 2 = 51%), cardiac mortality (OR 0.57; 95% CI 0.32–1.02, I 2 = 0%), new pacemaker implantation (OR = 3.11; 95% CI 0.58–16.60, I 2 = 89%), moderate/severe paravalvular leak (PVL; OR 3.50; 95% CI 0.64–19.10, I 2 = 54%) and rate of stroke (OR 0.63; 95% CI 0.34–1.15, I 2 = 39%) at 1‐year follow‐up. TAVR was found to have a significantly lower incidence of atrial fibrillation (AF; OR 0.15, 95% CI 0.10–0.24, I 2 = 38%) as compared to SAVR. Conclusion The results of our meta‐analysis demonstrate similar rates of all‐cause mortality, cardiac mortality, and stroke at 1‐year follow‐up in patients undergoing TAVR and SAVR. TAVR is associated with a lower incidence of AF relative to SAVR. However, there was a significantly higher incidence of PVL with TAVR compared to SAVR.