Ahmad Al-Abdouh1, Sireesha Upadhrasta2, Oluwaseun Fashanu3, Hadi Elias2, Di Zhao4, Rani K Hasan5, Erin D Michos6. 1. Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America. Electronic address: ahmad.al-abdouh@ascension.org. 2. Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America. 3. Department of Medicine, Saint Agnes Hospital, Baltimore, MD, United States of America; The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States of America. 4. Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America. 5. Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America. 6. The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, United States of America; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
Abstract
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become the standard treatment option for patients with symptomatic severe aortic stenosis (AS) with high surgical risk and a reasonable option for intermediate surgical risk as an alternative to surgical aortic valve replacement (SAVR). The role of TAVR in lower risk patients is less established but has been the focus of recent randomized controlled trials (RCTs). We performed a meta-analysis of RCTs to assess TAVR outcomes among low surgical risk patients. METHODS AND RESULTS: Systematic search of RCTs was done using PubMed, EMBASE, and Cochrane Library databases. Statistical analysis was performed with RevMan v5.3 software using a random effects model to report risk ratio (RR) with 95% confidence interval (CI). A total of three RCTs including 2698 patients (1375 TAVR and 1323 SAVR) were analyzed. Compared to SAVR, TAVR was not associated with all-cause mortality [RR 0.86 (95% CI 0.61-1.19); P = 0.36; I2 = 8%] or stroke [RR 0.82 (0.48-1.43); P = 0.49; I2 = 42%]. However, TAVR was significantly associated with lower risk of acute kidney injury [RR 0.27 (0.13-0.54); P = 0.0002; I2 = 0%], new-onset atrial fibrillation [RR 0.26 (0.18-0.39); P < 0.00001; I2 = 80%], and life-threatening or disabling bleeding [RR 0.35 (0.22-0.55); P < 0.00001; I2 = 57%], but a higher risk of moderate-severe paravalvular leak [RR 4.40 (1.22-15.86); P = 0.02; I2 = 26%] and permanent pacemaker insertion [RR 2.73 (1.41-5.28); P = 0.003; I2 = 83%]. CONCLUSIONS: There is no difference in all-cause mortality or stroke between TAVR and SAVR, but TAVR is associated with lower risk of other perioperative complications except for moderate-severe paravalvular leak and the need for permanent pacemaker implantation. Published by Elsevier Inc.
INTRODUCTION: Transcatheter aortic valve replacement (TAVR) has become the standard treatment option for patients with symptomatic severe aortic stenosis (AS) with high surgical risk and a reasonable option for intermediate surgical risk as an alternative to surgical aortic valve replacement (SAVR). The role of TAVR in lower risk patients is less established but has been the focus of recent randomized controlled trials (RCTs). We performed a meta-analysis of RCTs to assess TAVR outcomes among low surgical risk patients. METHODS AND RESULTS: Systematic search of RCTs was done using PubMed, EMBASE, and Cochrane Library databases. Statistical analysis was performed with RevMan v5.3 software using a random effects model to report risk ratio (RR) with 95% confidence interval (CI). A total of three RCTs including 2698 patients (1375 TAVR and 1323 SAVR) were analyzed. Compared to SAVR, TAVR was not associated with all-cause mortality [RR 0.86 (95% CI 0.61-1.19); P = 0.36; I2 = 8%] or stroke [RR 0.82 (0.48-1.43); P = 0.49; I2 = 42%]. However, TAVR was significantly associated with lower risk of acute kidney injury [RR 0.27 (0.13-0.54); P = 0.0002; I2 = 0%], new-onset atrial fibrillation [RR 0.26 (0.18-0.39); P < 0.00001; I2 = 80%], and life-threatening or disabling bleeding [RR 0.35 (0.22-0.55); P < 0.00001; I2 = 57%], but a higher risk of moderate-severe paravalvular leak [RR 4.40 (1.22-15.86); P = 0.02; I2 = 26%] and permanent pacemaker insertion [RR 2.73 (1.41-5.28); P = 0.003; I2 = 83%]. CONCLUSIONS: There is no difference in all-cause mortality or stroke between TAVR and SAVR, but TAVR is associated with lower risk of other perioperative complications except for moderate-severe paravalvular leak and the need for permanent pacemaker implantation. Published by Elsevier Inc.
Authors: Ahmed A Kolkailah; Rami Doukky; Marc P Pelletier; Annabelle S Volgman; Tsuyoshi Kaneko; Ashraf F Nabhan Journal: Cochrane Database Syst Rev Date: 2019-12-20