Review Article
2019 May 25. pii: S0002-9149(19)30584-3.
JOURNAL：Am J Cardiol.
Article Link
Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort
Ando T, Ashraf S, Villablanca P et al.
KEYWORDS
transcatheter aortic valve implantation; surgical aortic valve replacement; low-to-intermediate surgical risk cohort
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.
Copyright © 2019 Elsevier Inc. All rights reserved.
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