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
. 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

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.

PubMed Disclaimer

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.

References

    1. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, et al. . Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. (2012) 366:1686–95. 10.1056/NEJMoa1200384 - DOI - PubMed
    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. . 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. (2017) 38:2739–91. 10.1093/eurheartj/ehx391 - DOI - 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. N Engl J Med. (2016) 374:1609–20. 10.1056/NEJMoa1514616 - DOI - PubMed
    1. Gleason TG, Reardon MJ, Popma JJ, Deeb GM, Yakubov SJ, Lee JS, et al. . 5-Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol. (2018) 72:2687–96. 10.1016/j.jacc.2018.08.2146 - DOI - PubMed
    1. Fraccaro C, Tarantini G, Rosato S, Tellaroli P, D'Errigo P, Tamburino C, et al. Early and midterm outcome of propensity-matched intermediate-risk patients aged ≥80 years with aortic stenosis undergoing surgical or transcatheter aortic valve replacement (from the Italian Multicenter OBSERVANT Study). Am J Cardiol. (2016) 117:1494–501. 10.1016/j.amjcard.2016.02.020 - DOI - PubMed

Publication types

LinkOut - more resources