title: A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥1year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS.
  
  
  METHODS
  A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016.
  
  
  RESULTS
  Fifty studies enrolling 44,247 patients met the inclusion criteria. The mean duration follow-up was 21.4months. No difference was found in long-term all-cause mortality (risk ratios (RR), 1.06; 95% confidence interval (CI) 0.91-1.22). There was a significant difference favoring TAVR in the incidence of stroke (RR, 0.82; 95% CI 0.71-0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33-0.54), acute kidney injury (RR, 0.70; 95% CI 0.53-0.92), and major bleeding (RR, 0.57; 95% CI 0.40-0.81). TAVR had significant higher incidence of vascular complications (RR, 2.90; 95% CI 1.87-4.49), aortic regurgitation (RR, 7.00; 95% CI 5.27-9.30), and pacemaker implantation (PPM) (RR, 2.02; 95% CI 1.51-2.68). TAVR demonstrated significantly lower stroke risk compared to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06-2.10); no differences in PPM implantation were observed in intermediate-risk patients (RR, 1.68; 95% CI 0.94-3.00). In a meta-regression analysis, the effect of TAVR baseline clinical features did not affect the long-term all-cause mortality outcome.
  
  
  CONCLUSIONS
  TAVR and SAVR showed similar long-term survival in patients with severe AS; with important differences in treatment-associated morbidity.
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA. Electronic address: pvillabl@montefiore.org.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Villablanca
authors.affiliation: Division of Cardiology, Loyola University Stritch School of Medicine, Maywood, IL, USA.
authors.forename: Verghese
authors.initials: V
authors.lastname: Mathew
authors.affiliation: Emory University School of Medicine, Division of Cardiothoracic Surgery, Atlanta, GA, USA.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Québec Heart and Lung Institute, Quebec City, Quebec, Canada.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
authors.affiliation: New York University School of Medicine, New York, NY, USA.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Makkiya
authors.affiliation: Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Vlismas
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Briceno
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA; Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Slovut
authors.affiliation: Division of Cardiovascular Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Taub
authors.affiliation: Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.affiliation: Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D002986:Clinical Trials as Topic / Q000379:methods; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000639:trends; D006801:Humans; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000639:trends*; D016896:Treatment Outcome
keywords: Aortic stenosis; Meta-analysis; Surgical; Transcatheter