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

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1 Scopus citations

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)
Pages (from-to)e38-e41
JournalAmerican Journal of Medicine
Volume133
Issue number2
DOIs
StatePublished - Feb 2020

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

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    Kheiri, B., Osman, M., Bakhit, A., Radaideh, Q., Barbarawi, M., Zayed, Y., Golwala, H., Zahr, F., Stone, G. W., & Bhatt, D. L. (2020). Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients. American Journal of Medicine, 133(2), e38-e41. https://doi.org/10.1016/j.amjmed.2019.06.020