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Transcatether aortic valve replacement (TAVR) has emerged as an acceptable alternative to surgical aortic valve replacement (SAVR) in patients with high-risk surgical profile. In this analysis, we compare both approaches in patients with non-high surgical risk.
MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were queried from January 2000 through May 2016. Only studies comparing SAVR and TAVR were included enrolling patients with non-high surgical risk (low and intermediate risk only). Two independent reviewers selected the studies and extracted data in duplicate. Random-effects meta-analysis was used to pool outcomes across studies. Study primary endpoints were assessed at 1 and 12 months and included: mortality, cerebrovascular accident (CVA) and myocardial infarction (MI). Study secondary endpoints assessed at 1 month including: bleeding (minor and major), acute kidney injury and need for new permanent pacemaker implantation.
A total of 5223 patients were included from eight studies (4 randomized and 4 observant) comparing SAVR and TAVR. Mean age was 80.1 years and 49% of patients were male. There were no significant differences between the two approaches at one month in terms of mortality (risk ratio RR 0.91, 95% CI: 0.68 to 1.20), or CVA (RR 0.91, 95% CI 0.68 to 1.21). However, MI was lower in the TAVR group (RR 0.57, 95% CI 0.33 to 0.97). At 12 months, there was no significant difference between either strategies in terms of mortality (RR 0.98, 95% CI 0.84-1.13), CVA (RR1.07, 95% CI 0.85-1.33) or MI (RR 0.78, 95% CI 0.53-1.15). With regards to secondary outcomes, TAVR was associated with lower rates of bleeding (RR 0.44, 95% CI 0.22-0.88) and acute kidney injury (RR 0.54, 95% CI 0.31-0.93) but higher need for new permanent pacemaker implantation (RR 2.99, 95% CI 1.51-5.94).
In severe AS patients with non-high surgical risk, TAVR has lower risk of MI at one month, otherwise both TAVR and SAVR yielded similar outcomes at one month in terms of mortality and CVA and at 12 months in terms of mortality, CVA and MI. In regards to secondary outcomes at one month, TAVR has lower rates of bleeding and acute kidney injury, and higher rates of need for new permanent pacemakers.
Disclosure: Manuscript submitted to JOIC (under review).