Transcatheter aortic valve replacement versus surgical aortic valve replacement in low-surgical-risk patients: An updated meta-analysis

Sunny Goel, Ravi T. Pasam, Karan Wats, Jignesh Patel, Srilekha Chava, Joseph Gotesman, Bilal A. Malik, Robert Frankel, Jacob Shani, Umesh Gidwani

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Objective: The purpose of this meta-analysis is to compare the safety and efficacy of transcatheter aortic-valve replacement (TAVR) to surgical aortic valve replacement (SAVR) in low-surgical-risk patients. Background: TAVR is proven to be safe and effective in patients with high- and intermediate-risk aortic stenosis. However, there is limited data on the safety and efficacy of TAVR in patients with low surgical risk. Methods: We conducted an electronic database search of all published data for studies that compared TAVR to SAVR in low-surgical-risk patients (mean society for thoracic surgery [STS] score <4% and/or logistic EuroScore <10%) and reported on subsequent all-cause mortality, cardiac mortality, stroke rates, and other outcomes of interest. Event rates were compared with a forest plot of odds ratio using a random-effects model assuming interstudy heterogeneity. Results: A total of seven studies (n = 6,293 patients; TAVR = 2,912; and SAVR = 3,381) were included in the final analysis. There was no significant difference between TAVR and SAVR in terms of all-cause mortality (OR 0.82; 95% CI 0.50–1.36, I2 = 51%), cardiac mortality (OR 0.57; 95% CI 0.32–1.02, I2 = 0%), new pacemaker implantation (OR = 3.11; 95% CI 0.58–16.60, I2 = 89%), moderate/severe paravalvular leak (PVL; OR 3.50; 95% CI 0.64–19.10, I2 = 54%) and rate of stroke (OR 0.63; 95% CI 0.34–1.15, I2 = 39%) at 1-year follow-up. TAVR was found to have a significantly lower incidence of atrial fibrillation (AF; OR 0.15, 95% CI 0.10–0.24, I2 = 38%) as compared to SAVR. Conclusion: The results of our meta-analysis demonstrate similar rates of all-cause mortality, cardiac mortality, and stroke at 1-year follow-up in patients undergoing TAVR and SAVR. TAVR is associated with a lower incidence of AF relative to SAVR. However, there was a significantly higher incidence of PVL with TAVR compared to SAVR.

Original languageEnglish
Pages (from-to)169-178
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume96
Issue number1
DOIs
StatePublished - 1 Jul 2020

Keywords

  • SAVR
  • TAVR
  • mortality
  • stroke

Fingerprint

Dive into the research topics of 'Transcatheter aortic valve replacement versus surgical aortic valve replacement in low-surgical-risk patients: An updated meta-analysis'. Together they form a unique fingerprint.

Cite this