title: Early and intermediate survival after transcatheter aortic valve implantation: systematic review and meta-analysis of 14 studies.
abstract: BACKGROUND
  Transcatheter aortic valve implants (TAVIs) is indicated as an alternative to surgical valve replacement for patients unfit for surgery. No systematic review has studied survival after 2 years and limited information is available on between-study heterogeneity.
  
  
  OBJECTIVE
  A systematic review and meta-analysis on intermediate survival after TAVI.
  
  
  METHODS
  PubMed, EMBASE, Scopus and references of selected articles.
  
  
  METHODS
  Clinical studies evaluating TAVI, published between 2010 and 2012, reporting survival at 2 or more years.
  
  
  METHODS
  About 3500 patients from 14 studies.
  
  
  METHODS
  Proportion meta-analysis with 95% CI and heterogeneity assessment (I(2) and Cochran's Q). Meta-regression analysis was performed as well.
  
  
  RESULTS
  Pooled immediate postoperative death rate was 7.8% (95% CI 6.2% to 9.8%, I(2)=40.8%; Cochran's Q=97.7 with 92.9 df, p<0.0001) and stroke rate was 3.8% (95% CI 2.8% to 5.0%, I(2)=34.3%; Cochran's Q=96.5 with 92.9 df, p<0.0001). Pooled death rates at 1, 2 and 3 years were 23.2%, 31.0% and 38.6%, respectively. Among studies reporting on concomitant percutaneous coronary intervention, pooled death rates at 30 days, 1 year and 2 years were 6.3%, 17.8% and 25.8%, respectively.
  
  
  CONCLUSIONS
  Although our analysis examined a total of about 3500 patients, only a minority of these were actually followed up after 2 years.
  
  
  CONCLUSIONS
  Pooled survival rates after TAVI (at 2 years: 69.0%; at 3 years: 61.4%) can be considered excellent, particularly in the light of the high-risk profile of this patient population.   IMPLICATIONS OF KEY FINDINGS:  The favourable intermediate outcome in patients subjected to TAVI seems to justify its use in patients unfit for surgery. Such pooled results indicate that TAVI is a valid alternative to surgical valve replacement, but lack of data on late durability after TAVI prevents its use in low-risk patients with long expectancy of life.
authors: HTA Unit,  Estav Centro Toscana, Regional Health Service, Firenze and Prato,  Italy.
authors: Andrea
authors: A
authors: Messori
authors: Sabrina
authors: S
authors: Trippoli
authors: Fausto
authors: F
authors: Biancari