Abstract
Purpose: This study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients. Methods: An electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. Results: Five RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P =.049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P <.01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P <.01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P <.01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P <.01) compared with SAVR. Conclusion: Among older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
| Original language | English (US) |
|---|---|
| Journal | American Journal of Medicine |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
Fingerprint
Keywords
- Aortic stenosis
- Low risk
- Meta-analysis
- Surgical aortic valve replacement
- Transcatheter aortic valve replacement
ASJC Scopus subject areas
- Medicine(all)
Cite this
Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients. / Kheiri, Babikir; Osman, Mohammed; Bakhit, Ahmed; Radaideh, Qais; Barbarawi, Mahmoud; Zayed, Yazan; Golwala, Harsh; Zahr, Firas; Stone, Gregg W.; Bhatt, Deepak L.
In: American Journal of Medicine, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients
AU - Kheiri, Babikir
AU - Osman, Mohammed
AU - Bakhit, Ahmed
AU - Radaideh, Qais
AU - Barbarawi, Mahmoud
AU - Zayed, Yazan
AU - Golwala, Harsh
AU - Zahr, Firas
AU - Stone, Gregg W.
AU - Bhatt, Deepak L.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: This study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients. Methods: An electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. Results: Five RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P =.049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P <.01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P <.01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P <.01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P <.01) compared with SAVR. Conclusion: Among older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
AB - Purpose: This study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients. Methods: An electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. Results: Five RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P =.049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P <.01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P <.01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P <.01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P <.01) compared with SAVR. Conclusion: Among older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
KW - Aortic stenosis
KW - Low risk
KW - Meta-analysis
KW - Surgical aortic valve replacement
KW - Transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85070800711&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85070800711&partnerID=8YFLogxK
U2 - 10.1016/j.amjmed.2019.06.020
DO - 10.1016/j.amjmed.2019.06.020
M3 - Article
AN - SCOPUS:85070800711
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
ER -