Yanwei Wang1, Yijiang Zhou2, Li Zhang3, Jianhua Zhu4. 1. Department of Cardiology, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, PR China. 2. Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, PR China. 3. Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, PR China. Electronic address: li_zhang@zju.edu.cn. 4. Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, PR China. Electronic address: zjh_john@medmail.com.cn.
Abstract
BACKGROUND: Current guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk. METHODS: PubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up. Clinical endpoints including death, acute kidney injury, myocardial infarction, stroke, permanent pacemaker implantation, and life-threatening bleeding events were assessed. RESULTS: From 2000 to 2017, 4 clinical studies comprising 4355 patients were identified. At 2-year follow-up, TAVR was associated with similar rate of death from any cause (RR 0.86; 95%CI: 0.67-1.10), cardiovascular death (RR 0.88; 95%CI: 0.73-1.06), and stroke (RR 0.97; 95%CI: 0.81-1.15). TAVR reduced incidence of bleeding events (RR 0.45; 95%CI: 0.28-0.73) and acute kidney injury (RR 0.48; 95%CI: 0.25-0.93). However, TAVR was associated with higher rate of permanent pacemaker implantation (RR 3.01; 95%CI: 1.04-8.72). CONCLUSION: In patients at low to intermediate surgical risk, midterm clinical outcomes of TAVR were similar to SAVR in survival and stroke rate, superior in reducing life-threatening bleeding, acute kidney injury, and new-onset atrial fibrillation, but inferior in increasing permanent pacemaker implantation.
BACKGROUND: Current guidelines recommend transcatheter aortic valve replacement (TAVR) in patients with severe symptomatic aortic stenosis (AS) who are not suitable for conventional surgical aortic valve replacement (SAVR). In light of the recent trend in performing TAVR in patients with lower risk profile, we assessed the midterm outcome comparing TAVR and SAVR for the treatment of patients with severe AS at low to intermediate risk. METHODS: PubMed, EBSCO, and Cochrane CENTRAL were systematically searched for randomized controlled trials that reported the clinical outcomes of TAVR versus SAVR in patients at low to intermediate surgical risk with at least 2 years of follow-up. Clinical endpoints including death, acute kidney injury, myocardial infarction, stroke, permanent pacemaker implantation, and life-threatening bleeding events were assessed. RESULTS: From 2000 to 2017, 4 clinical studies comprising 4355 patients were identified. At 2-year follow-up, TAVR was associated with similar rate of death from any cause (RR 0.86; 95%CI: 0.67-1.10), cardiovascular death (RR 0.88; 95%CI: 0.73-1.06), and stroke (RR 0.97; 95%CI: 0.81-1.15). TAVR reduced incidence of bleeding events (RR 0.45; 95%CI: 0.28-0.73) and acute kidney injury (RR 0.48; 95%CI: 0.25-0.93). However, TAVR was associated with higher rate of permanent pacemaker implantation (RR 3.01; 95%CI: 1.04-8.72). CONCLUSION: In patients at low to intermediate surgical risk, midterm clinical outcomes of TAVR were similar to SAVR in survival and stroke rate, superior in reducing life-threatening bleeding, acute kidney injury, and new-onset atrial fibrillation, but inferior in increasing permanent pacemaker implantation.