Comparison of surgical versus transcatheter aortic valve replacement for patients with aortic stenosis at low-intermediate risk

• DOI: 10.21037/cdt.2020.02.11
• Publication Date: 2020-04-20T04:02:54Z
• Authors: Mahin R. Khan; Waleed T. Kayani; Malalai Manan; Ahmad Munir; Ihab Hamzeh; Salim S. Virani; Yochai Birnbaum; Hani Jneid; Mahboob Alam
• Keywords: Stroke; Valve replacement

To compare safety and efficacy of transcatheter aortic valve replacement (TAVR) with surgical (SAVR) in patients at low-intermediate risk, given the paucity robust data.We performed an aggregate data meta-analysis 7 randomized controlled trials (RCTs) 6,778 comparing TAVR SAVR for stenosis (AS) risk (Society Thoracic Surgeons risk-score ≤8%) using random-effects model. Primary outcome was all-cause mortality 30-day, 1-year 2-year follow-up. Secondary outcomes included cardiac-mortality, stroke, acute kidney injury (AKI), atrial fibrillation (AF), permanent pacemaker (PPM) implantation, major-bleeding, moderate-severe paravalvular regurgitation (PVR) rehospitalization.All-cause mortality, cardiac-mortality stroke were comparable between two groups. AF higher 30-day [odds ratio (OR) 0.17, 95% confidence intervals (CI): 0.12-0.24] thorough to (OR 0.34, CI: 0.21-0.55), while PPM implantation (30-day: OR 3.31, 1.64-6.66, 2-year: 3.17, 1.02-9.86). Moderate-severe PVR more prevalent all follow-ups. On inter-group comparison, low-risk group had even lower AF, but a as compared intermediate-risk undergoing TAVR.Compared SAVR, lower-risk associated low-intermediate-risk patients. Thus, highlighting need longer-term follow-up before inferences are drawn.