BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. METHODS: A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. RESULTS: Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. CONCLUSIONS: The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. METHODS: A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. RESULTS: Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. CONCLUSIONS: The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
Authors: Mohammad A Sherif; Mohamed Abdel-Wahab; Omar Awad; Volker Geist; Ghada El-Shahed; Reinhard Semmler; Mazen Tawfik; Ahmed A Khattab; Doreen Richardt; Gert Richardt; Ralph Tölg Journal: Am Heart J Date: 2010-11 Impact factor: 4.749
Authors: Craig R Smith; Martin B Leon; Michael J Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; Mathew Williams; Todd Dewey; Samir Kapadia; Vasilis Babaliaros; Vinod H Thourani; Paul Corso; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Jodi J Akin; William N Anderson; Duolao Wang; Stuart J Pocock Journal: N Engl J Med Date: 2011-06-05 Impact factor: 91.245
Authors: Nicolo Piazza; Menno van Gameren; Peter Jüni; Peter Wenaweser; Thierry Carrel; Yoshinobu Onuma; Brigitta Gahl; Gerrit Hellige; Amber Otten; Arie-Pieter Kappetein; Johanna J M Takkenberg; Ron van Domburg; Peter de Jaegere; Patrick W Serruys; Stephan Windecker Journal: EuroIntervention Date: 2009-11 Impact factor: 6.534
Authors: Alexander Ghanem; Andreas Müller; Claas P Nähle; Justine Kocurek; Nikos Werner; Christoph Hammerstingl; Hans H Schild; Jörg O Schwab; Fritz Mellert; Rolf Fimmers; Georg Nickenig; Daniel Thomas Journal: J Am Coll Cardiol Date: 2010-02-24 Impact factor: 24.094
Authors: Marie-Annick Clavel; John G Webb; Philippe Pibarot; Lukas Altwegg; Eric Dumont; Chris Thompson; Robert De Larochellière; Daniel Doyle; Jean-Bernard Masson; Sebastien Bergeron; Olivier F Bertrand; Josep Rodés-Cabau Journal: J Am Coll Cardiol Date: 2009-05-19 Impact factor: 24.094
Authors: Oren M Rotman; Brandon Kovarovic; Chander Sadasivan; Luis Gruberg; Baruch B Lieber; Danny Bluestein Journal: Cardiovasc Eng Technol Date: 2018-04-13 Impact factor: 2.495
Authors: Kevin Phan; Yi-Chin Tsai; Nithya Niranjan; Denis Bouchard; Thierry P Carrel; Otto E Dapunt; Harald C Eichstaedt; Theodor Fischlein; Borut Gersak; Mattia Glauber; Axel Haverich; Martin Misfeld; Peter J Oberwalder; Giuseppe Santarpino; Malakh Lal Shrestha; Marco Solinas; Marco Vola; Tristan D Yan; Marco Di Eusanio Journal: Ann Cardiothorac Surg Date: 2015-03
Authors: Akshay Shah; Helen Brambley; Miles Curtis; Michael Mullen; Nicola Delahunty; John Yap; Andrew Smith; Hugh Montgomery; Julie Sanders Journal: Intensive Care Med Date: 2015-06-03 Impact factor: 17.440
Authors: Jonathan Nadjiri; Hanna Nieberler; Eva Hendrich; Albrecht Will; Costanza Pellegrini; Oliver Husser; Christian Hengstenberg; Andreas Greiser; Stefan Martinoff; Martin Hadamitzky Journal: Int J Cardiovasc Imaging Date: 2016-07-26 Impact factor: 2.357