• Abdur Rahman Khan, Sobia Khan, Haris Riaz, Faraz Khan Luni, Herman Simo, Bin Abdulhak Aref A Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa., Chirag Bavishi, and Michael Flaherty.
• Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville, Louisville, Kentucky.
• Catheter Cardiovasc Interv. 2016 Nov 15; 88 (6): 934-944.

BackgroundThe efficacy of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients at high surgical risk has been established. The data on patients with intermediate risk is not conclusive. We performed a meta-analysis of studies which compared TAVR with surgical aortic valve replacement (SAVR) in patients at intermediate surgical risk.MethodsSeveral databases searched from inception to February 2015 yielded 7 eligible studies with 2,173 participants. The measured outcome of efficacy was all-cause mortality. Data on safety included stroke, permanent pacemaker implantation (PPI), aortic regurgitation (AR), vascular access complications, and major bleeding. Outcomes were pooled and relative risk (RR) was calculated with the Mantel-Haenszel method.ResultsThere was no difference in either short-term (RR, 1.02; 95% CI: 0.63-1.63; P = 0.94; I2  = 0%) or medium to long-term all-cause mortality (RR, 0.99; 95% CI: 0.81-1.21; P = 0.91; I2  = 0%). There was increased incidence of stroke (RR, 2.96; 95% CI: 0.87-10.09; P = 0.08; I2  = 0%), AR (RR, 3.59; 95% CI: 2.13-7.19; P < 0.00001; I2  = 2%), PPI (RR, 6.53; 95% CI: 1.91-22.32; P < 0.003; I2  = 0%) and vascular access complications (RR, 3.84; 95% CI: 0.65-22.76; P < 0.14; I2  = 48%) in patients with TAVR. There was a small, albeit increased risk of major or life threatening bleeding with SAVR as compared to TAVR (RR, 1.36; 95% CI: 1.04-1.80; P < 0.03; I2  = 0%).ConclusionsIn this meta-analysis we found that TAVR may be an acceptable alternative to SAVR in patients with intermediate risk for surgery. However, we must await evidence from the current large randomized trials before widespread adoption of this procedure is undertaken. © 2016 Wiley Periodicals, Inc.© 2016 Wiley Periodicals, Inc.

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