title: Transcatheter versus surgical aortic valve replacement in intermediate-risk patients: Evidence from a meta-analysis.
abstract: OBJECTIVE
  We performed a meta-analysis to evaluate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR) in intermediate-risk patients.
  
  
  BACKGROUND
  TAVR is an established treatment option in high-risk patients with severe aortic valve stenosis (AS). There are fewer data regarding efficacy of TAVR in intermediate-risk patients.
  
  
  METHODS
  Databases were searched through April 30, 2016 for studies that compared TAVR with SAVR for the treatment of intermediate-risk patients with severe AS. We calculated summary risk ratios (RRs) and 95% confidence intervals (CIs) with the random-effects model.
  
  
  RESULTS
  The analysis included 4,601 patients from 7 studies (2 randomized and 5 observational). There was no significant difference in all-cause mortality between the two groups after mean follow-up of 1.15 years [14.7% with TAVR vs 15.4% with SAVR; RR 0.93; 95% CI 0.77-1.12]. TAVR resulted in lower rates of acute kidney injury [number needed to treat (NNT) = 26], major bleeding (NNT = 4), and atrial-fibrillation (NNT = 6), but higher rates of major vascular complications [number needed to harm (NNH)= 18], and moderate/severe aortic regurgitation (NNH = 13). The rate of permanent-pacemaker implantation was significantly higher with TAVR in observational studies (RR 2.31; 95% CI 1.22-2.81), but not in RCTs (RR 1.21; 95% CI 0.93-1.56). No significant difference in the rate of stroke or myocardial infarction was observed.
  
  
  CONCLUSIONS
  Our analysis of mid-term results showed that TAVR has similar clinical efficacy to SAVR in intermediate-risk patients with severe AS, and can be a suitable alternative to surgical valve replacement. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Partha
authors.identifier: http://orcid.org/0000-0001-9647-2819
authors.initials: P
authors.lastname: Sardar
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Amartya
authors.initials: A
authors.lastname: Kundu
authors.affiliation: Division of Cardiology, Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Theophilus
authors.initials: T
authors.lastname: Owan
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kakouros
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Ramez
authors.initials: R
authors.lastname: Nairooz
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Pape
authors.affiliation: Department of Medicine, Division of Cardiology, Evanston Hospital, Evanston, Illinois.
authors.forename: Ted
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island.
authors.forename: J
authors.initials: J
authors.lastname: Dawn Abbott
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sammy
authors.initials: S
authors.lastname: Elmariah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: AVD - aortic valve disease; AVDP - aortic valve disease; TVI - transcatheter valve implantation; percutaneous intervention