Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Nov 15;124(10):1608-1614.
doi: 10.1016/j.amjcard.2019.07.066. Epub 2019 Aug 22.

Meta-analysis of Temporal and Surgical Risk Dependent Associations With Outcomes After Transcatheter Versus Surgical Aortic Valve Implantation

Safi U Khan  1 , Haris Riaz  2 , Muhammad U Khan  3 , Muhammad Samsoor Zarak  4 , Muhammad Zia Khan  3 , Muhammad Shahzeb Khan  5 , Sudhakar Sattur  6 , Milind Y Desai  2 , Edo Kaluski  6 , Mohamad Alkhouli  7
Affiliations
Review

Meta-analysis of Temporal and Surgical Risk Dependent Associations With Outcomes After Transcatheter Versus Surgical Aortic Valve Implantation

Safi U Khan et al. Am J Cardiol. .

Abstract

Temporal and surgical risk dependent associations with clinical outcomes in patients receiving transcatheter versus surgical aortic valve implantation (TAVI vs SAVI) are uncertain. In this meta-analysis, 7 randomized controlled trials (7,771 patients) were included to investigate trends in outcomes in TAVI versus SAVI up to 5 years, and variation in outcomes with respect to low-, intermediate-, and high-surgical risk of the patients up to 1 year. Estimates were calculated as random effects hazard ratios (HRs) with 95% confidence intervals (CI). All-cause mortality was similar in TAVI and SAVI at 30 days (HR 0.81, 95% CI 0.55 to 1.21, p = 0.31), 1 year (HR 0.97, 95% CI 0.89 to 1.06, p = 0.49), 2 years (HR 0.96, 95 CI 0.85 to 1.09, p = 0.54), and 5 years (HR 1.04, 95% CI 0.89 to 1.21, p = 0.62). Cardiac mortality, myocardial infarction and stroke were similar in both interventions up to 5 years. TAVI was associated with lower risk of atrial fibrillation, but higher risk of vascular complications, pacemaker implantation, and paravalvular leak up to 5 years. The lower risks of major bleeding and acute kidney injury with TAVI versus SAVI were limited to 1 and 2 years, respectively. Compared with SAVI, TAVI was superior in reducing all-cause mortality in low surgical risk patients at 30 days only, whereas TAVI was noninferior to SAVI in intermediate- and high-risk patients at 30 days and across all risks at 1 year. In conclusion, TAVI was noninferior to SAVI in terms of mortality, myocardial infarction, and stroke up to 5 years. TAVI improved survival versus SAVI in low-risk patients at 30 days.

PubMed Disclaimer

Conflict of interest statement

Disclosures

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Meta-analysis for all-cause mortality up to 5 years. EVOLUT, Transcatheter Aortic Valve Replacement With the Medtronic Transcatheter Aortic Valve Replacement System In Patients at Low Risk for Surgical Aortic Valve Replacement Trial; NOTION, Nordic Aortic Valve Intervention Trial; PARTNER, Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve Trial; SURTAVI, the Surgical Replacement and Transcatheter Aortic Valve Implantation trial; U.S. CoreValve, Medtronic CoreValve U.S. Pivotal Trial.
Figure 2.
Figure 2.
Meta-analysis for cardiac mortality up to 5 years. EVOLUT, Transcatheter Aortic Valve Replacement With the Medtronic Transcatheter Aortic Valve Replacement System In Patients at Low Risk for Surgical Aortic Valve Replacement Trial; NOTION, Nordic Aortic Valve Intervention Trial; PARTNER, Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve Trial; SURTAVI, the Surgical Replacement and Transcatheter Aortic Valve Implantation trial; U.S. CoreValve, Medtronic CoreValve U.S. Pivotal Trial.
Figure 3.
Figure 3.
Meta-analysis for all-cause mortality stratified by surgical risk of patients at 30 days and 1 year. EVOLUT, Transcatheter Aortic Valve Replacement With the Medtronic Transcatheter Aortic Valve Replacement System In Patients at Low Risk for Surgical Aortic Valve Replacement Trial; NOTION, Nordic Aortic Valve Intervention Trial; PARTNER, Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve Trial; SURTAVI, the Surgical Replacement and Transcatheter Aortic Valve Implantation trial; U.S. CoreValve, Medtronic CoreValve U.S. Pivotal Trial.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135:e1159–e1195. - PubMed
    1. Gargiulo G, Sannino A, Capodanno D, Barbanti M, Buccheri S, Perrino C, Capranzano P, Indolfi C, Trimarco B, Tamburino C, Esposito G. Transcatheter aortic valve implantation versus surgical aortic valve replacement: a systematic review and Meta-analysis. Ann Intern Med 2016;165:334–344. - PubMed
    1. Khan SU, Lone AN, Saleem MA, Kaluski E. Transcatheter vs surgical aortic-valve replacement in low- to intermediate-surgical-risk candidates: a meta-analysis and systematic review. Clin Cardiol 2017;40: 974–981. - PMC - PubMed
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, Bajwa T, Heiser JC, Merhi W, Kleiman NS, Askew J, Sorajja P, Rovin J, Chetcuti SJ, Adams DH, Teirstein PS, Zorn GL 3rd, Forrest JK, Tch etch e D, Resar J, Walton A, Piazza N, Ramlawi B, Robinson N, Petrossian G, Gleason TG, Oh JK, Boulware MJ, Qiao H, Mugglin AS, Reardon MJ. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019;380:1706–1715. - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Pibarot P, Leipsic J, Hahn RT, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Genereux P, Pershad A, Pocock SJ, Alu MC, Webb JG, Smith CR. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695–1705. - PubMed

MeSH terms