Valvular heart disease
A Meta-Analysis of Mortality and Major Adverse Cardiovascular and Cerebrovascular Events Following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis

https://doi.org/10.1016/j.amjcard.2013.05.015Get rights and content

The purpose of this meta-analysis was to compare postprocedural mortality and major adverse cardiovascular and cerebrovascular events between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic stenosis. Seventeen studies (n = 4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End points were baseline logistic European System for Cardiac Operative Risk Evaluation score, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, transient ischemic attack, and major bleeding events. Mean differences or risk ratios with 95% confidence intervals were computed, and p values <0.05 were considered significant. The population was matched for risk between the 2 groups on the basis of logistic European System for Cardiac Operative Risk Evaluation score for all outcomes except 30-day all-cause mortality, which had a high-risk population in the TAVI group (p = 0.02). There was no significant difference found in all-cause mortality at 30 days (p = 0.97) and at an average of 85 weeks (p = 0.07). There was no significant difference in cardiovascular mortality (p = 0.54) as well as the incidence of myocardial infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p = 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared with patients who underwent TAVI, those who underwent SAVR had a significantly higher frequency of major bleeding events (p <0.0001) at mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular and all-cause mortality to SAVR at early and long-term follow-up. TAVI is superior to SAVR for major bleeding complications and noninferior to SAVR for postprocedural myocardial infarctions and cerebrovascular events. TAVI is a safe alternative to SAVR in selected high-risk elderly patients with severe aortic stenosis.

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Methods

We performed this meta-analysis in accordance with the Meta-Analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements for reporting systematic reviews. General guidelines of the Cochrane Handbook for Systematic Reviews of Interventions, version 5.0.2, were used in developing the method, and the meta-analysis was conducted in adherence to these guidelines.6 We searched the National Library of Medicine's PubMed database,

Results

The search process is explained in Figure 1. Only 17 studies met the inclusion criteria and were included in our analysis. Overview and baseline patient characteristics are listed in Table 1. Smith et al8 published 1-year outcomes and Kodali et al9 published 2-year outcomes of same patients from the Placement of Aortic Transcatheter Valves (PARTNER) trial. Ten studies had matched propensity groups between TAVI and SAVR,8, 9, 10, 11, 12, 13, 14, 15, 16, 17 whereas in 6 studies, TAVI was

Discussion

Studies have shown conflicting results in mortality after TAVI compared with SAVR. However, our meta-analysis of these studies demonstrated that TAVI and SAVR have similar all-cause 30-day mortality despite higher risk patients in the TAVI group, which suggests that periprocedural mortality does not differ between TAVI and SAVR. Long-term all-cause mortality and cardiovascular mortality were also similar between TAVI and SAVR in our meta-analysis in a matched-risk population on the basis of

Disclosures

The authors have no conflicts of interest to disclose.

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