Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients at low to moderate surgical risk: a comprehensive meta-analysis

• Published in: BMC cardiovascular disorders 2017-08, Vol.17 (1), p.234-234, Article 234
• Main Authors: Elmaraezy, Ahmed, Ismail, Ammar, Abushouk, Abdelrahman Ibrahim, Eltoomy, Moutaz, Saad, Soha, Negida, Ahmed, Abdelaty, Osama Mahmoud, Abdallah, Ahmed Ramadan, Aboelfotoh, Ahmed Magdy, Hassan, Hossam Mahmoud, Elmaraezy, Aya Gamal, Morsi, Mahmoud, Althaher, Farah, Althaher, Moath, AlSafadi, Ammar M
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic valve replacement; Aortic valve stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bias; Bleeding; Cardiology; Cardiovascular disease; Care and treatment; Cerebral infarction; Chi-Square Distribution; Clinical trials; Electrocardiography; Female; Handbooks; Heart attacks; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Heart valve replacement; Hospitals; Humans; Kidneys; Male; Meta-analysis; Middle Aged; Mortality; Myocardial infarction; Odds Ratio; Patient outcomes; Patient Selection; Prosthesis Design; Regurgitation; Risk Assessment; Risk Factors; Stenosis; Stroke; Studies; Surgeons; Surgery; Surgical; Task forces; Thoracic surgery; Time Factors; Tomography; Transcatheter; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-017-0668-1

Recently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS. A systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows. At one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. Due to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.