title: Transcatheter versus surgical aortic valve replacement in moderate and high-risk patients: a meta-analysis.
abstract: The evidence of the benefits of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of high or intermediate surgical risk is not consistent. We performed a meta-analysis to compare major adverse outcomes after TAVR or SAVR.
  
  
  
  We searched propensity score matched studies or randomized clinical trials comparing the risks of mortality, stroke, major bleeding, acute renal injury, pacemaker implantation, vascular complications and prostheses haemodynamic performance between TAVR and SAVR in patients with moderate or high risk. Combined odds ratios (ORs), relative risk or mean differences with corresponding 95% confidence intervals (CIs) were calculated using a random effects model. Analyses of sensitivity and publication bias were also conducted.
  
  
  
  We included 5 clinical trials and 37 observational studies, enrolling 20 224 patients (TAVR, n  = 9099 and SAVR, n  = 11 125). The pooled analysis suggested no differences in early (OR = 1.11, 95% CI 0.9-1.39, P  = 0.355) or late mortality (relative risk = 0.91, 95% CI 0.78-1.05, P  = 0.194). TAVR was associated with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P  < 0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI 1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39). Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95% CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53).
  
  
  
  TAVR and SAVR have similar short and long-term all-cause mortality and risk of stroke among patients of moderate or high surgical risk. TAVR decreases the risk of major bleeding, acute kidney injury and improves haemodynamic performance compared with SAVR but increases the risk of vascular complications, the need for a pacemaker and residual aortic regurgitation.
authors.affiliation: Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Carnero-Alcázar
authors.affiliation: Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Maroto
authors.affiliation: Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Cobiella-Carnicer
authors.affiliation: Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Isidre
authors.initials: I
authors.lastname: Vilacosta
authors.affiliation: Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Ali
authors.initials: A
authors.lastname: Alswies
authors.affiliation: Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Villagrán-Medinilla
authors.affiliation: Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods / Q000401:mortality
keywords: Meta-analysis ; Surgical aortic valve replacement ; Transcatheter aortic valve replacement