Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients

Babikir Kheiri, Mohammed Osman, Ahmed Bakhit, Qais Radaideh, Mahmoud Barbarawi, Yazan Zayed, Harsh Golwala, Firas Zahr, Gregg W. Stone, Deepak L. Bhatt

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2019

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Meta-Analysis
Confidence Intervals
Aortic Valve
Surgical Instruments
Atrial Fibrillation
Randomized Controlled Trials
Stroke
Quality of Life
Hemorrhage
Mortality
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Databases
Safety

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kheiri, B., Osman, M., Bakhit, A., Radaideh, Q., Barbarawi, M., Zayed, Y., ... Bhatt, D. L. (Accepted/In press). Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients. American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2019.06.020

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 journalArticle

Kheiri, Babikir ; Osman, Mohammed ; Bakhit, Ahmed ; Radaideh, Qais ; Barbarawi, Mahmoud ; Zayed, Yazan ; Golwala, Harsh ; Zahr, Firas ; Stone, Gregg W. ; Bhatt, Deepak L. / Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients. In: American Journal of Medicine. 2019.
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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.",
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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.

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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

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