title: Worse survival after transcatheter aortic valve implantation than surgical aortic valve replacement: A meta-analysis of observational studies with a propensity-score analysis.
abstract: OBJECTIVE
  To determine whether transcatheter aortic valve implantation (TAVI) improves (or impairs) follow-up overall survival compared with surgical aortic valve replacement (SAVR), we performed a meta-analysis of observational studies with a propensity-score analysis and another meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  Databases including MEDLINE and EMBASE were searched through October 2015 using PubMed and OVID. Eligible studies were observational studies with a propensity-score analysis or RCTs of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting follow-up overall survival or all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) all-cause mortality for TAVI versus SAVR was abstracted from each individual study.
  
  
  RESULTS
  Our search identified 19 observational studies with a propensity-score analysis enrolling a total of 6234 patients. The arithmetic means of 1-year and 3-year survival rates were 82.7% and 71.3% after TAVI and 84.8% and 77.9% after SAVR, respectively. A pooled analysis demonstrated a statistically significant 21% increase in the hazard of mortality with TAVI relative to SAVR (HR, 1.21; 95% CI, 1.05 to 1.39; p=0.010). Another pooled analysis of 4 RCTs (enrolling a total of 1795 patients) demonstrated no statistically significant difference in mortality between TAVI and SAVR (HR, 0.92; 95% CI, 0.62 to 1.37; p=0.69).
  
  
  CONCLUSIONS
  The arithmetic mean of 3-year survival rates was 71.3% after TAVI and 77.9% after SAVR. Compared with SAVR, TAVI appears to be associated with a significant increase in follow-up all-cause mortality.
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. Electronic address: kfgth973@ybb.ne.jp.
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Umemoto
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D064887:Observational Studies as Topic; D010043:Outcome and Process Assessment, Health Care; D057216:Propensity Score; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*
keywords: Aortic valve replacement; Meta-analysis; Propensity-score analysis; Transcatheter aortic valve implantation