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Review
. 2024 Sep 26;16(9):e70268.
doi: 10.7759/cureus.70268. eCollection 2024 Sep.

Comparative Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Moderate-Risk Patients With Aortic Stenosis: A Systematic Review of Clinical Trials

Zeeshan Ajmal  1 , Zaeem Ur Rehman  2   3 , Ayesha Ishtiaq  4 , Hamdah Iftikhar  5 , Mohammad M Khokhar  6 , Bilal Khan  7 , Ali Asad  8   9 , Hannan Nasir  10 , Syed Muhammad Athar  8   11 , Ahmad Hassan  12   13 , Hira Naveed  14   15
Affiliations
Review

Comparative Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Moderate-Risk Patients With Aortic Stenosis: A Systematic Review of Clinical Trials

Zeeshan Ajmal et al. Cureus. .

Abstract

Aortic stenosis (AS) is a prevalent condition among the elderly, characterized by the narrowing of the aortic valve, which, if untreated, can lead to heart failure and decreased quality of life in terms of reduced activity and high mortality in one to two years. Surgical aortic valve replacement (SAVR) has long been the standard treatment for AS. However, it poses significant risks, particularly in older patients with comorbidities. In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative and is increasingly used in low- and moderate-risk patients. This review seeks to assess the comparative outcomes of TAVR and SAVR in patients with moderate-risk AS. A systematic review was conducted in accordance with PRISMA guidelines, focusing on randomized controlled trials (RCTs) that compared TAVR and SAVR in this patient population. Also, the review included three major RCTs: PARTNER 2, UK TAVI, and DEDICATE. We analyzed the key outcomes of TAVR and SAVR, such as mortality, reintervention rates, complications (such as myocardial infarction, prosthetic valve endocarditis, and pacemaker implantation), and reintervention rates, to evaluate the relative efficacy and safety of TAVR and SAVR. The analysis included data from 4,359 patients across the three trials. TAVR demonstrated a lower all-cause mortality in two of the three trials, with an overall trend favoring TAVR in terms of survival. However, TAVR was associated with a higher incidence of prosthetic valve endocarditis, a greater need for pacemaker implantation, and more frequent reinterventions compared to SAVR. In conclusion, the findings suggest that TAVR may be a better option for moderate-risk AS patients, offering higher survival rates and a less invasive recovery process. While TAVR carries increased risks of endocarditis and pacemaker dependency, its overall benefits, particularly in terms of lower mortality and improved patient outcomes, make it a preferable option over SAVR for many patients. However, acknowledging potential limitations such as variations in trial design and differences in patient populations would indeed provide a more comprehensive perspective. Further research and long-term follow-up are essential to confirm these findings and refine patient selection criteria.

Keywords: aortic stenosis; comparative outcomes; moderate-risk patients; surgical aortic valve replacement (savr); transcatheter aortic valve replacement.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram of study selection
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Risk estimates of all-cause mortality for transcatheter aortic valve replacement versus surgical aortic valve replacement
TAVR, transcatheter aortic valve replacement; SAVR, surgical aortic valve replacement
See this image and copyright information in PMC

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