Journal article
Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis.
- Siontis GCM Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Overtchouk P Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Cahill TJ Department of Cardiology, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Modine T Institut Coeur-Poumon, Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, CHRU de Lille, 2 Av Oscar Lambret, Lille, France.
- Prendergast B Department of Cardiology, St Thomas' Hospital, Westminster Bridge Rd, London, UK.
- Praz F Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Pilgrim T Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Petrinic T Cairns Library, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Nikolakopoulou A Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland.
- Salanti G Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, Bern, Switzerland.
- Søndergaard L Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, Denmark.
- Verma S Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
- Jüni P Department of Medicine and Institute of Health Policy, Management and Evaluation, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
- Windecker S Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- 2019-07-23
Published in:
- European heart journal. - 2019
Aortic stenosis
Low surgical risk
Meta-analysis
Surgical aortic valve replacement
Transcatheter aortic valve implantation
Transcatheter aortic valve replacement
Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Postoperative Complications
Transcatheter Aortic Valve Replacement
English
AIMS
Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients.
METHODS AND RESULTS
The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78-0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34-2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P < 0.001] compared to TAVI.
CONCLUSION
Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.
Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients.
METHODS AND RESULTS
The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78-0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34-2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P < 0.001] compared to TAVI.
CONCLUSION
Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/eurheartj/ehz275
- PMID 31329852
- Persistent URL
- https://folia.unifr.ch/global/documents/14792
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