title: Transcatheter Aortic Valve Replacement is Associated with Comparable Clinical Outcomes to Open Aortic Valve Surgery but with a Reduced Length of In-Patient Hospital Stay: A Systematic Review and Meta-Analysis of Randomised Trials.
abstract: BACKGROUND
  Aortic valve replacement is indicated in patients with severe symptomatic aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has evolved as a potential strategy in a growing proportion of patients in preference to surgical aortic valve replacement (SAVR). This meta-analysis aims to assess the differential outcomes of TAVR and SAVR in patients enrolled in published randomised controlled trials (RCTs).
  
  
  METHODS
  A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed MEDLINE was performed. Randomised controlled trials of patients with severe AS undergoing TAVR compared with SAVR were included. Clinical outcomes and procedural complications were assessed.
  
  
  RESULTS
  Five RCTs with a total of 3,828 patients (1,928 TAVR and 1,900 SAVR) were analysed. There was no statistically significant difference in combined rates of all-cause mortality and stroke at 30-days for TAVR vs SAVR (6.3% vs 7.5%; OR 0.83; 95% CI: 0.64-1.08; P=0.17) or at 12 months (17.2% vs 19.2%; OR 0.87; 95% CI: 0.73-1.03; P=0.29). No statistically significant difference was seen for death or stroke separately at any time point although a numerical trend in favour of TAVR for both was recorded. Length of in-patient stay was significantly less with TAVR vs SAVR (9.6 +/- 7.7 days vs 12.2 +/- 8.8 days; OR -2.94; 95% CI: -4.64 to -1.24; P=0.0007). Major vascular complications were more frequent in patients undergoing TAVR vs SAVR (8.2% vs. 4.0%; OR 2.15; 95% CI: 1.62-2.86; P <0.00001) but major bleeding was more common among SAVR patients (20.5% vs 44.2%; OR 0.34; 95% CI: 0.22-0.52; P=<0.00001).
  
  
  CONCLUSIONS
  Transcatheter aortic valve replacement and SAVR are associated with overall similar rates of death and stroke among patients in intermediate to high-risk cohorts but with reduced length of in-patient hospital stay.
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Burrage
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Moore
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Cole
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; The Wesley Hospital, Brisbane, QLD, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Cox
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Wing Chi
authors.initials: WC
authors.lastname: Lo
authors.affiliation: University of Queensland, Brisbane, QLD, Australia; The Wesley Hospital, Brisbane, QLD, Australia.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rafter
authors.affiliation: University of Queensland, Brisbane, QLD, Australia; The Wesley Hospital, Brisbane, QLD, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Garlick
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Garrahy
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; The Wesley Hospital, Brisbane, QLD, Australia. Electronic address: ACamuglia@heartcarepartners.com.au.
authors.forename: Anthony
authors.initials: A
authors.lastname: Camuglia
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods
keywords: Aortic stenosis; Surgical aortic valve replacement (SAVR); Transcatheter aortic valve replacement (TAVR)