• Hisato Takagi, Shohei Mitta, Tomo Ando, and ALICE (All-Literature Investigation of Cardiovascular Evidence) group.
• Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
• Catheter Cardiovasc Interv. 2018 Aug 1; 92 (2): 419-430.

ObjectivesTo synthesize evidence regarding long-term survival after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) from real-world clinical practice, we performed a meta-analysis of observational studies with a propensity-score analysis and ≥3-year follow-up.MethodsDatabases including MEDLINE and EMBASE were searched through April 2017 using PubMed and OVID. Eligible studies were observational comparative studies with a propensity-score analysis of TAVI versus SAVR enrolling patients with severe AS and reporting ≥3-year all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) mortality for TAVI versus SAVR was extracted from each individual study.ResultsOur search identified 14 eligible studies enrolling a total of 4,197 patients. A pooled analysis of all the 14 studies demonstrated a statistically significant 54% increase in mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for effect < 0.00001; P for heterogeneity = 0.14; I2  = 30%). Several sensitivity analyses did not substantially change the statistically significant benefit for SAVR. There was no evidence of significant publication bias.ConclusionsOn the basis of a meta-analysis of 14 observational comparative studies with a propensity-score analysis including a total of ≥4,000 patients, TAVI is associated with worse ≥3-year overall survival than SAVR.© 2018 Wiley Periodicals, Inc.

30 keywords...

hide…