title: Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: a meta analysis.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to surgery for those at very high or prohibitive surgical risk. We performed a meta-analysis to evaluate the comparative benefits of TAVI versus surgical aortic valve replacement (SAVR) in patients with severe AS.
  
  
  METHODS
  A comprehensive literature search of PubMed, Embase, ScienceDirect and Cochrane Central Register of Controlled trials was performed, and randomized trials as well as cohort studies with propensity score analysis were included.
  
  
  RESULTS
  One randomized trial (n = 699) and six retrospective cohort studies (n = 781) were selected for meta-analysis. Mortality at 30-day and 1-year follow-up was comparable between TAVI and SAVR. Despite similar incidences of stroke, myocardial infarction, re-operation for bleeding, and renal failure requiring dialysis, TAVI was associated with a lower occurrence rate of new-onset atrial fibrillation (OR 0.51, 95%CI 0.33 - 0.78) and shorter procedural time (mean difference -67.50 minutes, 95%CI -87.20 to -47.81 minutes). Post-operative aortic regurgitation and permanent pacemaker implantation were more common in patients after TAVI than in those with SAVR (OR 5.53, 95%CI 3.41 - 8.97; OR 1.71, 95%CI 1.02 - 2.84, respectively).
  
  
  CONCLUSIONS
  In patients with severe symptomatic AS, TAVI and SAVR did not differ with respect to short- and mid-term survival, but the incidence of permanent pacemaker implantation and post-procedural aortic regurgitation remain relatively high after TAVI.
authors.affiliation: Department of Cardiac Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Wu
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Zhang
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Shen
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhao
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery* / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans