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

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posted on 2023-02-13, 11:34 authored by Yousif Ahmad, James Howard, Ahran Arnold, Mahesh Madhavan, Christopher Cook, Maria Alu, Michael Mack, Michael Reardon, Vinod Thourani, Samir Kapadia, Hans Thyregod, Lars Sondergaard, Troels Jorgensen, William Toff, Nicolas Van Mieghem, Raj Makkar, Jon Forrest, Martin Leon

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 and results

The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 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.

History

Author affiliation

Department of Cardiovascular Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

European Heart Journal

Publisher

Oxford University Press (OUP) for European Society of Cardiology

issn

0195-668X

eissn

1522-9645

Copyright date

2023

Available date

2024-01-20

Language

en

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