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. 2021 Feb 10:7:612155.
doi: 10.3389/fcvm.2020.612155. eCollection 2020.

Transcatheter and Surgical Aortic Valve Replacement in Patients With Previous Cardiac Surgery: A Meta-Analysis

Yi-Ming Li  1 , Jia-Yu Tsauo  1 , Kai-Yu Jia  1 , Yan-Biao Liao  1 , Fan Xia  2 , Zheng-Gang Zhao  1 , Mao Chen  1 , Yong Peng  1
Affiliations

Transcatheter and Surgical Aortic Valve Replacement in Patients With Previous Cardiac Surgery: A Meta-Analysis

Yi-Ming Li et al. Front Cardiovasc Med. .

Abstract

Background: Many patients who have aortic stenosis and are transcatheter aortic valve replacement (TAVR) candidates have underwent prior cardiac surgery (PCS). The aim of this study was to provide a robust summary comparison between patients with PCS who underwent TAVR vs. surgical aortic valve replacement (SAVR). Methods: We conducted a systematic review and meta-analysis of all published articles on PubMed/Medline, Ovid, EMBASE, and Scopus from 2002 to 2019. Results: A total of 13 studies were finally included, yielding a total of 23,148 participants. There was no statistical difference with 30-day [OR: 1.02 (0.86-1.21)] or 1-year mortality [OR: 1.18 (0.86-1.61)] between the two groups. Subgroup analysis revealed that high-risk patients who underwent TAVR with the transapical approach were associated with increased risk of mortality [OR: 1.45 (1.00-2.11)]. However, those who underwent TAVR with endovascular approach had a comparable outcome with SAVR. Conclusions: Primary outcomes after endovascular TAVR were similar to those with SAVR and superior to transapical TAVR treatment group in patients with PCS.

Keywords: aortic stenosis; meta-analysis; previous cardiac surgery; surgical aortic valve replacement; transcatheter aortic valve replacement.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
The meta-analysis for (A) 30-day mortality, (B) 1-year mortality, and (C) overall follow-up mortality.
Figure 3
Figure 3
The meta-analysis for post-procedural complications as (A) stroke, (B) bleeding (major or worse), (C) length of stay, (D) acute kidney injury, and (E) permanent pacemaker implantation.
Figure 4
Figure 4
Subgroup analysis by surgical risk classification: (A) 30-day mortality and (B) overall follow-up mortality.
Figure 5
Figure 5
Subgroup analysis by access: (A) 30-day mortality and (B) overall follow up mortality. EV, endovascular; TA, transapical.
See this image and copyright information in PMC

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