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Review
. 2021 Jan 26;11(1):128-134.
doi: 10.1080/20009666.2020.1843235.

Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis

Azka Latif  1 , Muhammad Junaid Ahsan  1 , Noman Lateef  1 , Vikas Kapoor  1 , Mohsin Mansoor Mirza  1 , Faiz Anwer  2 , Michael Del Core  3 , Arun Kanmantha Reddy  3
Affiliations
Review

Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis

Azka Latif et al. J Community Hosp Intern Med Perspect. .

Abstract

Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay. Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76-1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62-0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62-0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70-1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65-4.333), p < 0.001]. Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home.

Keywords: Nonagenarians; SAVR; TAVR; elderly; in-hospital outcomes; short-term outcomes; surgical aortic valve replacement; trans-catheter aortic valve replacement.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Prisma Flow diagram for study selection
Figure 2.
Figure 2.
The incidence of short-term Mortality between transcatheter aortic valve replacement versus surgical aortic valve replacement
Figure 3.
Figure 3.
Overall hospital stay in the patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement
Figure 4.
Figure 4.
The incidence of post-operative acute kidney injury in the patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement
See this image and copyright information in PMC

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