Abstract 15554: Improvement of Valvular Parameters Following Transcatheter Aoritc Valve Implantation versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis: A Meta-Analysis
Background: Surgical aortic valve replacement (SAVR) is the standard of care for severe aortic valve stenosis (AS). In patients with high risk for surgery, transcatheter aortic valve implantation (TAVI) is an alternative approach and has been evolved. The purpose of this meta-analysis is to compare post-procedural improvement of valvular parameters following TAVI versus SAVR for severe aortic stenosis.
Methods: Nine studies (n=2411) comparing SAVR (n=1363) and TAVI (n=1048) procedures were included. End points were baseline logistic EuroSCORE, aortic valve area in cm2 and mean and peak trans-aortic pressure gradients in mm Hg. The mean difference (MD) with 95% confidence interval (CI) was computed for each outcome and p<0.05 was considered as a level of significance.
Results: There was no difference in baseline logistic EuroSCORE between patients in TAVI and SAVR groups (MD: 6.13, CI: -0.14 to 12.41, p=0.06). There was no significant difference found in aortic valve area between TAVI and SAVR groups (MD: -0.07, CI: -0.54 to 0.39, p=0.75) (Figure A). The mean and peak trans-aortic pressure gradients were significantly lower following TAVI compared to SAVR (MD: -2.19, CI: -3.64 to -0.73, p=0.003; MD: -2.40, CI: -2.65 to -2.14, p<0.00001 respectively) (Figure B).
Conclusion: This meta-analysis of 9 studies in 2411 propensity score matched patients with severe aortic stenosis demonstrated that replacement of aortic valve with TAVI procedure may provide better valve performance compared to SAVR. Long-term echocardiographic assessment of valvular area and trans-aortic gradients is needed for further evaluation.
- © 2013 by American Heart Association, Inc.