Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials

Yousif Ahmad, James P. Howard, Ahran D. Arnold, Mahesh V. Madhavan, Christopher M. Cook, Maria Alu, Michael J. Mack, Michael J. Reardon, Vinod H. Thourani, Samir Kapadia, Hans Gustav Hørsted Thyregod, Lars Sondergaard, Troels Højsgaard Jørgensen, William D. Toff, Nicolas M. Van Mieghem, Raj R. Makkar, John K. Forrest, Martin B. Leon

Research output: Contribution to journalReview articlepeer-review

28 Scopus citations

Abstract

Aims Additional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methods The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after and results 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion In lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.

Original languageEnglish (US)
Pages (from-to)836-852
Number of pages17
JournalEuropean heart journal
Volume44
Issue number10
DOIs
StatePublished - Mar 7 2023

Keywords

  • Aortic stenosis
  • Meta-analysis
  • Surgical aortic valve replacement
  • Transcatheter aortic valve replacement
  • Humans
  • Heart Valve Prosthesis Implantation/methods
  • Risk Factors
  • Aortic Valve Stenosis
  • Aortic Valve/surgery
  • Treatment Outcome
  • Stroke/epidemiology
  • Randomized Controlled Trials as Topic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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