Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-analysis.
BACKGROUND
The comparative benefits and harms of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for patients with aortic stenosis are unclear.


OBJECTIVE
To compare clinical outcomes, including early (≤30-day) and midterm (≤1-year) mortality, in adults with severe aortic stenosis undergoing either TAVI or SAVR.


METHODS
MEDLINE, Cochrane, and Scopus databases (without language restrictions) from April 2002 to 5 April 2016; multiple registries and Web sites; scientific meeting presentations.


METHODS
Five randomized trials and 31 observational matched studies comparing mortality outcomes after TAVI or SAVR.


METHODS
Two investigators independently extracted study data and rated risk of bias.


RESULTS
16 638 patients were analyzed. Overall, there was no statistically significant difference between TAVI and SAVR in early (odds ratio [OR], 1.01 [95% CI, 0.81 to 1.26]) or midterm (OR, 0.96 [CI, 0.81 to 1.14]) all-cause mortality. Analyses restricted to trials (early: OR, 0.80 [CI, 0.51 to 1.25]; midterm: OR, 0.90 [CI, 0.64 to 1.26]) were inconclusive, with wide CIs, whereas analyses of matched studies were similar to the overall results. Transfemoral TAVI provided mortality benefits over SAVR in trials. Analyses restricted to studies of patients at low to intermediate risk showed statistically nonsignificant reductions in early (OR, 0.67 [CI, 0.42 to 1.07]) and midterm (OR, 0.91 [CI, 0.67 to 1.23]) mortality with TAVI. Incidence of periprocedural myocardial infarction, major bleeding, acute kidney injury, and new-onset atrial fibrillation was lower with TAVI, but risk for pacemaker implantation, vascular complications, and paravalvular leak increased. Overall, there was a statistically nonsignificant increased risk in long-term (2- to 5-year) all-cause mortality with TAVI (OR, 1.28 [CI, 0.97 to 1.69]), whereas long-term mortality outcomes in patients at low to intermediate risk were inconclusive, with wide CIs (OR, 1.06 [CI, 0.59 to 1.91]).


CONCLUSIONS
The number of trials was limited, and study designs and patient characteristics were heterogeneous.


CONCLUSIONS
Compared with SAVR, TAVI may have similar or better early and midterm outcomes for adults with aortic stenosis, including those at low to intermediate risk.


BACKGROUND
None.
Giuseppe
G
Gargiulo
Anna
A
Sannino
Davide
D
Capodanno
Marco
M
Barbanti
Sergio
S
Buccheri
Cinzia
C
Perrino
Piera
P
Capranzano
Ciro
C
Indolfi
Bruno
B
Trimarco
Corrado
C
Tamburino
Giovanni
G
Esposito
D000328:Adult; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D002423:Cause of Death; D057186:Comparative Effectiveness Research; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D016896:Treatment Outcome