Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis - PubMed (original) (raw)
Meta-Analysis
. 2019 Oct 7;40(38):3143-3153.
doi: 10.1093/eurheartj/ehz275.
Pavel Overtchouk 1, Thomas J Cahill 2, Thomas Modine 3, Bernard Prendergast 4, Fabien Praz 1, Thomas Pilgrim 1, Tatjana Petrinic 5, Adriani Nikolakopoulou 6, Georgia Salanti 6, Lars Søndergaard 7, Subodh Verma 8, Peter Jüni 9, Stephan Windecker 1
Affiliations
- PMID: 31329852
- DOI: 10.1093/eurheartj/ehz275
Free article
Meta-Analysis
Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis
George C M Siontis et al. Eur Heart J. 2019.
Free article
Abstract
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.
Keywords: Aortic stenosis; Low surgical risk; Meta-analysis; Surgical aortic valve replacement; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
Comment in
- The final meta-analysis?
Webb JG, Landes U. Webb JG, et al. Eur Heart J. 2019 Oct 7;40(38):3154-3155. doi: 10.1093/eurheartj/ehz696. Eur Heart J. 2019. PMID: 31573604 No abstract available. - Aortenklappen-Ersatz: chirurgische oder kathetertechnische Methode.
Steurer J. Steurer J. Praxis (Bern 1994). 2020 Jan;109(1):54-55. doi: 10.1024/1661-8157/a003375. Praxis (Bern 1994). 2020. PMID: 31910757 German. No abstract available.