Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis.

Siontis, George CM; Overtchouk, Pavel; Cahill, Thomas J; Modine, Thomas; Prendergast, Bernard; Praz, Fabien; Pilgrim, Thomas; Petrinic, Tatjana; Nikolakopoulou, Adriani; Salanti, Georgia; Søndergaard, Lars; Verma, Subodh; Jüni, Peter; Windecker, Stephan (2019). Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. European Heart Journal, 40(38), pp. 3143-3153. Oxford University Press 10.1093/eurheartj/ehz275

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AIMS  Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients. METHODS AND RESULTS  The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78-0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68-0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34-2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47-3.64), P < 0.001] compared to TAVI. CONCLUSION  Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Siontis, Georgios; Overtchouk, Pavel; Praz, Fabien; Pilgrim, Thomas; Nikolakopoulou, Adriani; Salanti, Georgia and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

31 Jul 2019 10:03

Last Modified:

10 Mar 2020 10:35

Publisher DOI:

10.1093/eurheartj/ehz275

PubMed ID:

31329852

Additional Information:

Siontis, Overtchouk, Cahill contributed equally to this work

Uncontrolled Keywords:

Aortic stenosis Low surgical risk Meta-analysis Surgical aortic valve replacement Transcatheter aortic valve implantation Transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.132211

URI:

https://boris.unibe.ch/id/eprint/132211

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