Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort

• Published in: The American journal of cardiology 2019-08, Vol.124 (4), p.580-585
• Main Authors: Ando, Tomo, Ashraf, Said, Villablanca, Pedro, Kuno, Toshiki, Pahuja, Mohit, Shokr, Mohamed, Afonso, Luis, Grines, Cindy, Briasoulis, Alexandros, Takagi, Hisato
• Format: Article
• Language: English
• Subjects: Aortic valve; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Asymmetry; Bias; Cardiac arrhythmia; Clinical trials; Confidence intervals; Consortia; Diabetes; Diabetes mellitus; Health risks; Heart Valve Prosthesis Implantation - methods; Humans; Implantation; Meta-analysis; Mortality; Online data bases; Regression analysis; Risk; Risk Assessment; Sensitivity analysis; Severity of Illness Index; Stroke; Stroke - epidemiology; Surgical implants; Systematic review; Transcatheter Aortic Valve Replacement - methods; Transplants & implants; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.05.017

Transcatheter aortic valve implantation (TAVI) has been used to treat high surgical risk cohorts but has been expanded to treat low-to-intermediate risk cohort as well. We performed a systematic review and meta-analysis to compare the outcomes between TAVI and surgical aortic valve replacement (SAVR) in low-to-intermediate risk cohort. We queried PUBMED, EMBASE, and ClinicalTrial.gov for relevant articles. Randomized controlled trials that compared at least one of the outcomes of interest between TAVI and SAVR were included. Risk ratio (RR) and 95% confidence interval (CI) were pooled with a random-effects model to compare the risk of the primary outcome between the 2 procedures. The primary outcome was a composite of all-cause mortality or disabling/major stroke at 1 year. Seven studies with a total of 7,143 patients (3,665 TAVI) were included. All-cause mortality or disabling/major stroke at 30 days (6 studies, RR 0.71, 95% CI 0.49 to 1.03) was similar between TAVI and SAVR but was significantly lower in TAVI at 1 year (5 studies, RR 0.81, 95% CI 0.67 to 0.98). All-cause mortality was similar at both 30 days (7 studies, RR 0.90, 95% CI 0.67 to 1.21) and 1 year (6 studies, RR 0.89, 95% CI 0.76 to 1.04). Disabling/major stroke was similar between the 2 procedures (6 studies, RR 0.69, 95% CI 0.42 to 1.12) at 30 days but was significantly lower in TAVI at 1 year (5 studies RR 0.71, 95% CI 0.51 to 0.98). Age, gender, diabetes, and surgical risk score did not modulate the primary outcome. TAVI had a significantly lower composite of all-cause mortality or disabling/major stroke at 1 year compared with SAVR in low-to-intermediate surgical risk cohort.