Abstract 12579: Efficacy and Safety of Transcatheter Aortic Valve Replacement in Low-Moderate Surgical Risk Patients: A Systematic Review and Meta-analysis
Background: The efficacy of transcatheter aortic valve replacement (TAVR) in patients at high surgical risk has been established. The data in patients with low-moderate risk for surgery is still not conclusive. We sought to perform a meta-analysis of studies comparing the safety and efficacy of TAVR with surgical aortic valve replacement (SAVR).
Methods: Several databases were searched from inception to February 2015, which yielded 10 eligible studies. Studies were selected if they compared TAVR to SAVR in patients at low-moderate risk for surgery. The measured outcomes of efficacy were all-cause and cardiovascular mortality. Data on safety included cerebrovascular events (CVA), permanent pacemaker implantation (PPI), aortic regurgitation (AR), vascular access complications and major bleeding reported during the procedure. Outcomes were pooled and relative risk was calculated using the Mantel-Haenszel method using a random effects or a fixed effect model based on heterogeneity. If studies had zero events in any of the arms, Peto odds ratio was used to pool data.
Results: There were 10 studies with 3107 participants in our analysis. There was no difference in either short-term (RR, 0.85; CI: 0.57–1.28; p=0.44; I2=0%) or medium to long-term all-cause mortality (RR, 0.97; CI: 0.80–1.18; p=0.78; I2=0%). Our analysis suggested a decreased risk of cardiovascular mortality in the short-term (RR, 0.42; CI: 0.19–0.91; p=0.03; I2=0%) and a statistically non-significant trend towards decrease in long-term mortality (RR, 0.53; CI: 0.26–1.08; p=0.08; I2=0%) with TAVR. There was increased incidence of AR (RR, 4.01; CI: 2.24–7.19; p< 0.00001; I2=0%), PPI (RR, 5.00; CI: 3.47–7.19; p< 0.00001; I2=21%) and vascular access complications (RR, 6.36; CI: 3.75–10.76; p< 0.00001; I2=27%) in patients with TAVR. There was no difference in the risk of stroke between TAVR and SAVR (RR, 1.17; CI: 0.62–2.21; p=0.64; I2=15%) and an increased risk of major bleeding with SAVR was found (RR, 1.81; CI: 1.08–3.03; p< 0.0001; I2=86%).
Conclusions: In this meta-analysis we found that TAVR may be an acceptable alternative to SAVR in patients with low-moderate risk for surgery. However, more evidence is needed from the current randomized trials before more widespread adoption of the procedure.
- Transcatheter Aortic Valve Replacement
- Surgical Aortic Valve Replacement
- Low-moderate risk
Author Disclosures: A.R. Khan: None. S. Khan: None. H. Simo: None. F.K. Luni: None. A.A. Bin Abdulhak: None. C. Bavishi: None. H. Riaz: None. M.P. Flaherty: None.
- © 2015 by American Heart Association, Inc.