title: Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: Meta-Analysis of Clinical Outcomes and Cost-Effectiveness.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has emerged as a feasible alternative treatment to conventional surgical aortic valve replacement (AVR) for high-risk patients with aortic stenosis. The present systematic review aimed to assess the comparative clinical and cost-effectiveness outcomes of TAVI versus AVR, and meta-analyse standardized clinical endpoints.
  
  
  METHODS
  An electronic search was conducted on 9 online databases to identify all relevant studies. Eligible studies had to report on either periprocedural mortality or incremental cost-effectiveness ratio (ICER) to be included for analysis.
  
  
  RESULTS
  The systematic review identified 24 studies that reported on comparative clinical outcomes, including three randomized controlled trials and ten matched observational studies involving 7906 patients. Meta-analysis demonstrated no significant differences in regards to mortality, stroke, myocardial infarction or acute renal failure. Patients who underwent TAVI were more likely to experience major vascular complications or arrhythmias requiring permanent pacemaker insertion. Patients who underwent AVR were more likely to experience major bleeding. Eleven analyses from 7 economic studies reported on ICER. Six analyses defined TAVI to be low value, 2 analyses defined TAVI to be intermediate value, and three analyses defined TAVI to be high value.
  
  
  CONCLUSIONS
  The present study demonstrated no significant differences in regards to mortality or stroke between the two therapeutic procedures. However, the cost-effectiveness and long-term efficacy of TAVI may require further investigation. Technological improvement and increased experience may broaden the clinical indication for TAVI for low-intermediate risk patients in the future.
authors.affiliation: The Systematic Reviews Unit, The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia. drchriscao@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cao
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Liou
authors.forename: Faraz K
authors.initials: FK
authors.lastname: Pathan
authors.forename: Sohaib
authors.initials: S
authors.lastname: Virk
authors.forename: Robert
authors.initials: R
authors.lastname: McMonnies
authors.forename: Hugh
authors.initials: H
authors.lastname: Wolfenden
authors.forename: Praveen
authors.initials: P
authors.lastname: Indraratna
mesh_terms: D003362:Cost-Benefit Analysis; D019918:Heart Valve Prosthesis Implantation / Q000191:economics*; D006801:Humans; D065467:Transcatheter Aortic Valve Replacement / Q000191:economics*; D016896:Treatment Outcome