Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-Risk Patients: A Meta-Analysis Based On a 2-Year Follow-Up

Abstract Background: Previous studies have shown that transcatheter aortic valve implantation (TAVI) is the best alternative therapy to surgical aortic valve replacement (SAVR) in high-risk surgical patients with aortic stenosis (AS). However, it is not clear whether TAVI can be utilised in low-risk surgical patients with AS. This study aimed to evaluate the safety and efficacy of TAVI in low-risk patients.Methods: From the outset of our initiative until June 2021, PubMed, EMBASE, and Cochrane were thoroughly searched, yielding the selection of 3 randomised controlled trials including 2633 patients with AS, to assess outcome measures at distinct follow-up time periods. Results: The mean Society of Thoracic Surgeons Predicted Risk of Mortality score of patients was 2.2. At the 30-day and 1-year follow-up, TAVI was associated with a lower incidence of all-cause mortality, cardiovascular mortality, acute kidney injury (stage 2 or 3), life-threatening or significant bleeding, and new atrial fibrillation (NAF), but an increased risk of permanent pacemaker implantation. At the 2-year follow-up, TAVI only had an advantage in NAF (RR, 0.27; 95% CI, 0.14–0.51; P＜0.0001) without any significant difference in any of the other outcome measures.Conclusions: For low-risk surgical patients with AS, the efficacy of TAVI was superior to that of SAVR by the 30-day and 1-year follow-up. This was most evident by the 2-year follow-up, except for the advantages of NAF, with no other significant differences.

Download Full-text

Faculty Opinions recommendation of Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Low-Risk Patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726343474.793519982 ◽

2016 ◽

Author(s):

André Coetzee

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Low Risk ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000507 ◽

2018 ◽

Vol 13 (3) ◽

pp. 153-162 ◽

Cited By ~ 2

Author(s):

Juan A. Siordia ◽

Jackquelin M. Loera ◽

Matt Scanlon ◽

Jessie Evans ◽

Peter A. Knight

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Low Risk ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.

Download Full-text

Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Low-Risk Patients

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.115.003326 ◽

2016 ◽

Vol 9 (5) ◽

Cited By ~ 67

Author(s):

Stefano Rosato ◽

Francesco Santini ◽

Marco Barbanti ◽

Fausto Biancari ◽

Paola D’Errigo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Low Risk ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

Meta-Analysis Comparing Transcatheter Aortic Valve Implantation to Surgical Aortic Valve Replacement in Low Surgical Risk Patients

The American Journal of Cardiology ◽

10.1016/j.amjcard.2019.07.029 ◽

2019 ◽

Vol 124 (8) ◽

pp. 1257-1264 ◽

Cited By ~ 1

Author(s):

Sameer Saleem ◽

Sundas Younas ◽

Mubbasher Ameer Syed

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Meta Analysis ◽

Surgical Aortic Valve Replacement ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

0069 : Early and late outcome after transcatheter aortic valve implantation or surgical aortic valve replacement for high risk patients with aortic stenosis: a monocentric experience

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(16)30509-2 ◽

2016 ◽

Vol 8 (3) ◽

pp. 259

Author(s):

Marion Chauvet ◽

Claire Bouleti ◽

Dominique Himbert ◽

Bernard Iung ◽

Eric Brochet ◽

...

Keyword(s):

High Risk ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Surgical Aortic Valve Replacement ◽

Late Outcome ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

A 3-Center Comparison of 1-Year Mortality Outcomes Between Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on the Basis of Propensity Score Matching Among Intermediate-Risk Surgical Patients

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2013.01.136 ◽

2013 ◽

Vol 6 (5) ◽

pp. 443-451 ◽

Cited By ~ 157

Author(s):

Nicolo Piazza ◽

Bindu Kalesan ◽

Nicolas van Mieghem ◽

Stuart Head ◽

Peter Wenaweser ◽

...

Keyword(s):

Aortic Valve ◽

Propensity Score ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Surgical Patients ◽

Intermediate Risk ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

Transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients: a propensity score-matched analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz245 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1131-1139 ◽

Cited By ~ 6

Author(s):

Andreas Schaefer ◽

Niklas Schofer ◽

Alina Goßling ◽

Moritz Seiffert ◽

Johannes Schirmer ◽

...

Keyword(s):

Aortic Valve ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Low Risk ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Risk Patients ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract OBJECTIVES The aim of the study was to determine the differences in outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in low-risk patients. METHODS All patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI between 2008 and 2016 (n = 955) or SAVR between 2009 and 2014 (n = 886) at our centre were included. One hundred and nine patients per group were available for propensity score matching. RESULTS Mortality during the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%, P = 1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%, P < 0.001) and paravalvular leakage ≥ moderate (0.0 vs 7.0%, P = 0.017) were higher in TAVI patients. No difference was found regarding postoperative effective orifice area and transvalvular pressure gradients. Although, the 1-year survival was similar between both groups; 3- and 5-year survival was significantly inferior in the TAVI patient cohort. CONCLUSIONS TAVI yielded similar short-term outcomes compared with SAVR despite higher rates of permanent pacemaker implantation and paravalvular leakage ≥ moderate, but inferior long-term survival. Poorer long-term outcomes of the TAVI patient cohort were attributable to a more comorbid TAVI population. This emphasizes the need for long-term results from randomized controlled trials before TAVI can be broadly expanded to younger low-risk patients.

Download Full-text