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Meta-Analysis
. 2019 Dec 20;12(12):CD013319.
doi: 10.1002/14651858.CD013319.pub2.

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

Ahmed A Kolkailah  1 , Rami Doukky  2 , Marc P Pelletier  3 , Annabelle S Volgman  4 , Tsuyoshi Kaneko  5 , Ashraf F Nabhan  6
Affiliations
Meta-Analysis

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

Ahmed A Kolkailah et al. Cochrane Database Syst Rev. .

Abstract

Background: Severe aortic valve stenosis (AS) is a major cause of morbidity and mortality worldwide. The definitive management for severe AS is aortic valve replacement (AVR). The choice of transcatheter approach versus open-heart surgery for AVR in people with severe AS and low surgical risk remains a matter of debate.

Objectives: To assess the benefits and harms of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in people with severe AS and low surgical risk.

Search methods: We searched the following databases for randomised controlled trials (RCTs) on 29 April 2019: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science Core Collection. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We searched all databases from inception to present and imposed no restriction on language or date of publication.

Selection criteria: We included RCTs that compared TAVI and SAVR in adults (18 years of age or older) with severe AS and low surgical risk.

Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Two authors independently screened titles and abstracts for inclusion, performed data extraction, and assessed risk of bias in the studies included. We analysed dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with respective 95% confidence intervals (CI). We assessed the certainty of evidence for each outcome using the GRADE approach. Our outcomes of interest were assessed in the short term (i.e. during hospitalisation and up to 30 days of follow-up). Primary outcomes were all-cause mortality, stroke, and rehospitalisation. Secondary outcomes were myocardial infarction (MI), cardiac death, length of hospital stay (LOS), permanent pacemaker (PPM) implantation, new-onset atrial fibrillation, acute kidney injury (AKI), and any bleeding.

Main results: We identified four studies (13 reports), with 2818 participants, and one ongoing study. Overall certainty of evidence ranged from high to very low. There is probably little or no difference between TAVI and SAVR for the following short-term outcomes: all-cause mortality (RR 0.69, 95% CI 0.33 to 1.44; SAVR 11 deaths per 1000, TAVI 8 deaths per 1000 (95% CI 4 to 16); 2818 participants; 4 studies; moderate-certainty evidence); stroke (RR 0.73, 95% CI 0.42 to 1.25; SAVR 21 strokes per 1000, TAVI 16 strokes per 1000 (95% CI 9 to 27); 2818 participants; 4 studies; moderate-certainty evidence); MI (RR 0.82, 95% CI 0.42 to 1.58; SAVR 14 MI per 1000, TAVI 11 MI per 1000 (95% CI 6 to 21); 2748 participants; 3 studies; moderate-certainty evidence); and cardiac death (RR 0.71, 95% CI 0.32 to 1.56; SAVR 10 cardiac deaths per 1000, TAVI 7 cardiac deaths per 1000 (95% CI 3 to 16); 2818 participants; 4 studies; moderate-certainty evidence). TAVI may reduce the risk of short-term rehospitalisation, although the confidence interval also includes the possibility of no difference in risk between groups (RR 0.64, 95% CI 0.39 to 1.06; SAVR 30 cases per 1000, TAVI 19 cases per 1000 (95% CI 12 to 32); 2468 participants; 2 studies; low-certainty evidence). TAVI, compared with SAVR, probably increases the risk of PPM implantation (RR 3.65, 95% CI 1.50 to 8.87; SAVR 47 per 1000, TAVI 170 cases per 1000 (95% CI 70 to 413); number needed to treat for an additional harmful outcome (NNTH) = 7; 2683 participants; 3 studies; moderate-certainty evidence). We are uncertain whether TAVI, compared with SAVR, affects the LOS in days, although it appears to be associated with shorter LOS. TAVI, compared with SAVR, reduces the risk of atrial fibrillation (RR 0.21, 95% CI 0.15 to 0.30; 2683 participants; 3 studies), AKI (RR 0.30, 95% CI 0.16 to 0.58; 2753 participants; 4 studies), and bleeding (RR 0.31, 95% CI 0.16 to 0.62; 2753 participants; 4 studies) (all high-certainty evidence).

Authors' conclusions: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, especially durability, in the low surgical risk population.

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Conflict of interest statement

AK: No conflicts of interest to disclose.

RD: No conflicts of interest to disclose.

MP: Consultancy work for Abbott Medical and LivaNova. Received funds to attend a Cryolife Investigators Meeting.

AV: No conflicts of interest to disclose.

TK: Speaker Bureau/Proctor for Edwards Lifesciences, Medtronic, and Abbott Vascular.

AN: No conflicts of interest to disclose.

Figures

1
1
PRISMA study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 1 Short‐term all‐cause mortality.
1.2
1.2. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 2 Short‐term all‐cause mortality (sensitivity analysis).
1.3
1.3. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 3 Long‐term all‐cause mortality.
1.4
1.4. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 4 Short‐term stroke.
1.5
1.5. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 5 Short‐term stroke (sensitivity analysis).
1.6
1.6. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 6 Long‐term stroke.
1.7
1.7. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 7 Short‐term rehospitalisation.
1.8
1.8. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 8 Long‐term rehospitalisation.
1.9
1.9. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 9 Short‐term myocardial infarction.
1.10
1.10. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 10 Long‐term myocardial infarction.
1.11
1.11. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 11 Short‐term cardiac death.
1.12
1.12. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 12 Long‐term cardiac death.
1.13
1.13. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 13 Length of hospital stay.
1.14
1.14. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 14 Short‐term new‐onset atrial fibrillation.
1.15
1.15. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 15 Long‐term new‐onset atrial fibrillation.
1.16
1.16. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 16 Short‐term permanent pacemaker implantation.
1.17
1.17. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 17 Long‐term permanent pacemaker implantation.
1.18
1.18. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 18 Acute kidney injury.
1.19
1.19. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 19 Short‐term bleeding.
1.20
1.20. Analysis
Comparison 1 Transcatheter aortic valve implantation versus surgical aortic valve replacement, Outcome 20 Long‐term bleeding.
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References

References to studies included in this review

Evolut 2019 {published data only}
    1. NCT02701283. Medtronic Evolut transcatheter aortic valve replacement in low risk patients [Transcatheter aortic valve replacement with the medtronic transcatheter aortic valve replacement system in patients at low risk for surgical aortic valve replacement]. clinicaltrials.gov/ct2/show/NCT02701283 first posted March 8, 2016.
    1. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O'Hair D, et al. Transcatheter aortic‐valve replacement with a self‐expanding valve in low‐risk patients. The New England Journal of Medicine 2019;380(18):1706‐715. - PubMed
NOTION 2015 {published data only}
    1. Jørgensen TH, Thyregod HG, Tarp JB, Svendsen JH, Søndergaard L. Temporal changes of new‐onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement. International Journal of Cardiology 2017;234:16‐21. - PubMed
    1. NCT01057173. The Nordic Aortic Valve Intervention trial (NOTION) [Transcatheter versus surgical aortic valve implantation in patients with severe aortic valve stenosis]. clinicaltrials.gov/ct2/show/NCT01057173 first posted January 27, 2010.
    1. Søndergaard L, Ihlemann N, Capodanno D, Jørgensen T, Nissen H, Kjeldsen BJ, et al. Durability of transcatheter and surgical bioprosthetic aortic valves in patients at lower surgical Risk. Journal of the American College of Cardiology 2019;73(5):546–53. - PubMed
    1. Søndergaard L, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P. Two‐year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all‐comers Nordic Aortic Valve Intervention randomized clinical trial. Circulation: Cardiovascular Interventions 2016;9(6):e003665. - PubMed
    1. Thyregod HG, Ihlemann N, Jørgensen TH, Nissen H, Kjeldsen BJ, Petursson P, et al. Five‐year clinical and echocardiographic outcomes from the Nordic Aortic Valve Intervention (NOTION) randomized clinical trial in lower surgical risk patients. Circulation 2019;139:2714–23. - PubMed
PARTNER 3 2019 {published data only}
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic‐valve replacement with a balloon‐expandable valve in low‐risk patients. The New England Journal of Medicine 2019;380(18):1695‐705. - PubMed
    1. NCT02675114. The PARTNER 3 ‐ trial ‐ the safety and effectiveness of the SAPIEN 3 transcatheter heart valve in low risk Patients with aortic stenosis (P3) [A prospective, randomized, controlled, multi‐center study to establish the safety and effectiveness of the SAPIEN 3 transcatheter heart valve in low risk patients who have severe, calcific, aortic stenosis requiring aortic valve replacement]. clinicaltrials.gov/ct2/show/NCT02675114 first posted February 5, 2016.
STACCATO 2012 {published data only}
    1. Nielsen HH, Klaaborg KE, Nissen H, Terp K, Mortensen PE, Kjeldsen BJ, et al. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. EuroIntervention 2012;8:383‐89. - PubMed
    1. Ryhammer PK, Greisen J, Jakobsen CJ. Hemodynamic consequences following surgical aortic valve replacement versus transcatheter aortic valve implantation ‐ a randomized study. Acta Anaesthesiologica Scandinavica 2015;11:11.

References to studies excluded from this review

NCT02628899 {published data only}
    1. NCT02628899. Feasibility of transcatheter aortic valve replacement in low‐risk patients with symptomatic, severe aortic stenosis. clinicaltrials.gov/ct2/show/NCT02628899 first posted December 11, 2015.
NCT02838199 {published data only}
    1. NCT02838199. Transcatheter or surgIcal aortic valve replacement in all‐comers with severe aortic valve stenosis (TRANSIT) [Prospective, open label, multicenter, dual arm, randomized trial of transcatheter or surgIcal aortic valve replacement in all‐comers with severe aortic valve stenosis]. clinicaltrials.gov/ct2/show/NCT02838199 first posted July 20, 2016.
SURTAVI 2017 {published data only}
    1. Reardon MJ, Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al. Surgical or transcatheter aortic‐valve replacement in intermediate‐risk patients. The New England Journal of Medicine 2017;376(14):1321‐31. - PubMed
    1. Serruys PW, Modolo R, Reardon M, Miyazaki Y, Windecker S, Popma J, et al. One‐year outcomes of patients with severe aortic stenosis andan STS PROM of less than three percent in the SURTAVI trial. EuroIntervention 2018;14(8):877‐83. - PubMed

References to studies awaiting assessment

NCT03112980 {published data only}
    1. NCT03112980. Randomized trial of TAVI vs. SAVR in patients with severe aortic valve stenosis at intermediate risk of mortality (DEDICATE) [Randomized, multi‐center, event‐driven trial of TAVI versus SAVR in patients with symptomatic severe aortic valve stenosis and intermediate risk of mortality, as assessed by STS‐score ‐ DEDICATE]. clinicaltrials.gov/ct2/show/NCT03112980 first posted April 13, 2017.
NCT03383445 {published data only}
    1. NCT03383445. Transcatheter aortic valve replacement versus surgical aortic valve replacement for treating elderly patients with severe aortic stenosis and small aortic annuli: a prospective randomized study The VIVA trial. clinicaltrials.gov/ct2/show/NCT03383445 first posted December 26, 2017.
PARTNER 2 2016 {published data only}
    1. Baron SJ, Wang K, House JA, Magnuson EA, Reynolds MR, Makkar R, et al. Cost‐effectiveness of transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at intermediate risk. Circulation 2019;139(7):877‐88. - PubMed
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic‐valve replacement in intermediate‐risk Patients. The New England Journal of Medicine 2016;374(17):1609‐20. - PubMed

References to ongoing studies

NCT02825134 {published data only}
    1. NCT02825134. Comparison of transcatheter versus surgical aortic valve replacement in younger low surgical risk patients with severe aortic stenosis (NOTION‐2) [Nordic Aortic Valve Intervention trial 2 ‐ a randomized multicenter comparison of transcatheter versus surgical aortic valve replacement in younger low surgical risk patients with severe aortic stenosis]. clinicaltrials.gov/ct2/show/NCT02825134 first posted July 7, 2016.

Additional references

Al‐Abdouh 2019
    1. Al‐Abdouh A, Upadhrasta S, Fashanu O, Elias H, Zhao D, Hasan RK, et al. Transcatheter aortic valve replacement in low‐risk patients: A meta‐analysis of randomized controlled trials. Cardiovascular Revascularization Medicine 2019; Vol. pii: S1553‐8389(19)30481‐6. - PubMed
Arora 2017
    1. Arora S, Strassle PD, Ramm CJ, Rhodes JA, Vaidya SR, Caranasos TG, et al. Transcatheter versus surgical aortic valve replacement in patients with lower surgical risk scores: a systematic review and meta‐analysis of early outcomes. Heart, Lung & Circulation 2017;26(8):840‐5. - PubMed
Baumgartner 2017a
    1. Baumgartner H, Hung J, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. European Heart Journal 2017;18(3):254‐75. - PubMed
Baumgartner 2017b
    1. Baumgartner H, Falk V, Bax JJ, Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2017;38(36):2739–91. - PubMed
Bhatia 2016
    1. Bhatia N, Basra SS, Skolnick AH, Wenger NK. Aortic valve disease in the older adult. Journal of Geriatric Cardiology 2016;13(12):941‐4. - PMC - PubMed
Clegg 2012
    1. Clegg SD, Krantz MJ. Transcatheter aortic valve replacement: what's in a name?. Journal of the American College of Cardiology 2012;60(3):239. - PubMed
FDA 2019
    1. FDA expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open‐heart surgery. www.fda.gov/news‐events/press‐announcements/fda‐expands‐indication‐sever... 16 August 2019.
GRADEpro GDT 2015 [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 21 March 2019. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Greenbaum 2017
    1. Greenbaum AB, Babaliaros VC, Chen MY, Stine AM, Rogers T, O’Neill WW, et al. Transcaval access and closure for transcatheter aortic valve replacement: a prospective investigation. Journal of the American College of Cardiology 2017;69(5):511‐21. - PMC - PubMed
Grimard 2016
    1. Grimard BH, Safford RE, Burns EL. Aortic stenosis: diagnosis and treatment. American Family Physician 2016;93(5):371‐8. - PubMed
Grover 2017
    1. Grover FL, Vemulapalli S, Carroll JD, Edwards FH, Mack MJ, Thourani VH, et al. STS/ACC TVT Registry. 2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Journal of the American College of Cardiology 2017;69(10):1215–30. - PubMed
Higgins 2017
    1. Higgins JP, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). The Cochrane Collaboration, 2017. Available at www.training.cochrane.org/handbook.
Hirji 2017
    1. Hirji SA, Ramirez‐Del Val F, Kolkailah AA, Ejiofor JI, McGurk S, Chowdhury R, et al. Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians ‐ surgery still the gold standard?. Annals of Cardiothoracic Surgery 2017;6(5):453‐62. - PMC - PubMed
Hirji 2018a
    1. Hirji SA, Kolkailah AA, Ramirez‐Del Val F, Lee J, McGurk S, Pelletier P, et al. Mechanical versus bioprosthetic aortic valve replacement in patients aged 50 years and younger. Annals of Thoracic Surgery 2018;106(4):1113‐21. - PubMed
Hirji 2018b
    1. Hirji SA, Funamoto M, Lee J, Ramirez Del Val F, Kolkailah AA, McGurk S, et al. Minimally invasive versus full sternotomy aortic valve replacement in low‐risk patients: which will stand against transcatheter aortic valve replacement?. Surgery 2018;164(2):282‐7. - PubMed
Junquera 2019
    1. Junquera L, Ferreira‐Neto A, Guimaraes L, Asmarats L, Val D, Wintzer‐Wehekind J. Transcatheter aortic valve replacement in low risk patients. Minerva Cardioangiologica 2019;67(1):19‐38. - PubMed
Kheiri 2019
    1. Kheiri B, Osman M, Abubakar H, Subahi A, Chahine A, Ahmed S, et al. Transcatheter versus surgical aortic valve replacement in low‐risk surgical patients: a meta‐analysis of randomized clinical trials. Cardiovascular Revascularization Medicine 2019;pii:S1553‐8389(18)30626‐2. - PubMed
Kolkailah 2018
    1. Kolkailah AA, Hirji SA, Ejiofor JI, Ramirez Del Val F, Lee J, Norman AV, et al. Novel fast‐track recovery protocol for alternative access transcatheter aortic valve replacement: application to non‐femoral approaches. Interactive CardioVascular and Thoracic Surgery 2018;26:938–43. - PubMed
Kolte 2019
    1. Kolte D, Vlahakes GJ, Palacios IF, Sakhuja R, Passeri JJ, Inglessis I, et al. Transcatheter versus surgical aortic valve replacement in low‐risk patients. Journal of the American College of Cardiology 2019;74(12):1532‐40. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. In: Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Leon 2010
    1. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG. Transcatheter aortic‐valve implantation for aortic stenosis in patients who cannot undergo surgery. New England Journal of Medicine 2010;363(17):1597‐607. - PubMed
Leon 2016
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic‐valve replacement in intermediate‐risk patients. New England Journal of Medicine 2016;374:1609‐20. - PubMed
Liberati 2009
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta‐analyses of studies that evaluate health care interventions: explanation and elaboration. PLOS Medicine 2009;6(7):e1000100. - PMC - PubMed
Maganti 2010
    1. Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clinic Proceedings 2010;85(5):483‐500. - PMC - PubMed
Mylotte 2016
    1. Mylotte D, Sudre A, Teiger E, Obadia JF, Lee M, Spence M, et al. Transcarotid transcatheter aortic valve replacement: feasibility and safety. Journal of the American College of Cardiology: Cardiovascular Interventions 2016;9(5):472–80. - PubMed
Nashef 2012
    1. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. European Journal of Cardio‐thoracic Surgery 2012;41(4):734–45. - PubMed
Nishimura 2017
    1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 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:e1159‐95. - PubMed
O'Brien 2009
    1. O'Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2 ‐ isolated valve surgery. Annals of Thoracic Surgery 2009;88(Suppl 1):S23‐42. - PubMed
Overtchouk 2019
    1. Overtchouk P, Prendergast B, Modine T. Why should we extend transcatheter aortic valve implantation to low‐risk patients? A comprehensive review. Archives of Cardiovascular Diseases 2019;112(5):354‐62. - PubMed
Piazza 2008
    1. Piazza N, Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circulation: Cardiovascular Interventions 2008;1(1):74‐81. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Schünemann 2013
    1. Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE Handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013. Available from guidelinedevelopment.org/handbook.
Schünemann 2017
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JP, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017). The Cochrane Collaboration, 2017. Available from www.training.cochrane.org/handbook.
Thourani 2015
    1. Thourani VH, Li C, Devireddy C, Jensen HA, Kilgo P, Leshnower BG, et al. High‐risk patients with inoperative aortic stenosis: use of transapical, transaortic, and transcarotid techniques. Annals of Thoracic Surgery 2015;99(3):817–23; discussion 823‐5. - PubMed
Witberg 2018
    1. Witberg G, Lador A, Yahav D, Kornowski R. Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: a meta‐analysis of randomized trials and propensity score matched observational studies. Catheterization and Cardiovascular Interventions 2018;92(2):408‐16. - PubMed
Witberg 2019
    1. Witberg G, Landes U, Lador A, Yahav D, Kornowski R. Meta‐analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients at low surgical risk. EuroIntervention 2019; Vol. Jaa‐659 2019, doi: 10.4244/EIJD‐19‐00663. - PubMed

References to other published versions of this review

Kolkailah 2019
    1. Kolkailah AA, Doukky R, Pelletier MP, Kaneko T, Nabhan AF. Transcatheter versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk. Cochrane Database of Systematic Reviews 2019, Issue 4. [DOI: 10.1002/14651858.CD013319] - DOI - PMC - PubMed

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