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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.

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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

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