title: Meta-Analysis of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis.
abstract: Transcatheter aortic valve replacement (TAVR) is a viable option in the treatment of severe aortic stenosis in patients at high risk for surgery. We sought to further investigate outcomes in patients at low to intermediate risk with aortic stenosis who underwent surgical aortic valve replacement (SAVR) versus TAVR. We systematically searched the electronic databases, MEDLINE, PubMed, EMBASE, and Cochrane for prospective cohort studies of the effects of TAVR versus SAVR on clinical outcomes (30-day mortality, all-cause mortality, stroke and myocardial infarction, major vascular complications, paravalvular regurgitation, permanent pacemaker implantation, major bleeding, and acute kidney injury). We identified 5 clinical studies, examining 1,618 patients in the TAVR group and 1,581 patients in the SAVR group with an average follow-up of 1.05 years. No difference in all-cause mortality, stroke, and myocardial infarction between the 2 approaches was found. TAVR was associated with higher rates of vascular complications, permanent pacemaker implantation, and moderate or severe paravalvular regurgitation (p <0.001 for all), whereas more major bleeding events were seen in the SAVR group (p <0.001). In conclusion, TAVR was found to have similar survival and stroke rates and lower major bleeding rates as compared with SAVR in patients at low or intermediate surgical risk. However, SAVR was associated with less pacemaker placements and paravalvular regurgitation rates.
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kondur
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan. Electronic address: alexbriasoulis@gmail.com.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Mohan
authors.initials: M
authors.lastname: Palla
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Anirudh
authors.initials: A
authors.lastname: Penumetcha
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Sagar
authors.initials: S
authors.lastname: Mallikethi-Reddy
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Apurva
authors.initials: A
authors.lastname: Badheka
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome