• Hisato Takagi, Takuya Umemoto, and ALICE (All-Literature Investigation of Cardiovascular Evidence) Group.
• Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. Electronic address: kfgth973@ybb.ne.jp.
• Int. J. Cardiol. 2016 Oct 1; 220: 320-7.

ObjectivesTo determine whether transcatheter aortic valve implantation (TAVI) improves (or impairs) follow-up overall survival compared with surgical aortic valve replacement (SAVR), we performed a meta-analysis of observational studies with a propensity-score analysis and another meta-analysis of randomized controlled trials (RCTs).MethodsDatabases including MEDLINE and EMBASE were searched through October 2015 using PubMed and OVID. Eligible studies were observational studies with a propensity-score analysis or RCTs of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting follow-up overall survival or all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) all-cause mortality for TAVI versus SAVR was abstracted from each individual study.ResultsOur search identified 19 observational studies with a propensity-score analysis enrolling a total of 6234 patients. The arithmetic means of 1-year and 3-year survival rates were 82.7% and 71.3% after TAVI and 84.8% and 77.9% after SAVR, respectively. A pooled analysis demonstrated a statistically significant 21% increase in the hazard of mortality with TAVI relative to SAVR (HR, 1.21; 95% CI, 1.05 to 1.39; p=0.010). Another pooled analysis of 4 RCTs (enrolling a total of 1795 patients) demonstrated no statistically significant difference in mortality between TAVI and SAVR (HR, 0.92; 95% CI, 0.62 to 1.37; p=0.69).ConclusionsThe arithmetic mean of 3-year survival rates was 71.3% after TAVI and 77.9% after SAVR. Compared with SAVR, TAVI appears to be associated with a significant increase in follow-up all-cause mortality.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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