• Amartya Kundu, Partha Sardar, Rohit Malhotra, Waqas T Qureshi, and Nikolaos Kakouros.
• Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, United States. Electronic address: Amartya.kundu@umassmemorial.org.
• Cardiovasc Revasc Med. 2020 Apr 1; 21 (4): 453-460.

BackgroundTAVR is an established treatment option in high and intermediate-risk patients with severe AS. There is less data regarding the efficacy of TAVR in low-risk patients. This meta-analysis evaluated efficacy and safety outcomes of transcatheter aortic valve replacement (TAVR) in comparison to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis (AS).MethodsDatabases were searched for randomized controlled trials (RCTs) that compared TAVR with SAVR for the treatment of low-risk patients with severe AS. We calculated pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the random-effects model.ResultsThe final analysis included 2953 patients from 5 studies. Compared to SAVR, TAVR was associated with similar mid-term mortality [OR 0.67; 95% CI 0.37-1.21; p = 0.18], as well as similar short-term mortality [OR 0.51; 95% CI 0.24-1.11; p = 0.09]. Randomization to TAVR was associated with a reduced risk of developing acute kidney injury [OR 0.26; 95% CI 0.13-0.52; p < 0.001], short-term major bleeding [OR 0.27; 95% CI 0.12-0.60; p < 0.001] and new-onset atrial fibrillation [OR 0.17; 95% CI 0.14-0.21; p < 0.001]. However, TAVR was associated with a higher risk of requiring permanent pacemaker implantation [OR 4.25; 95% CI 1.86-9.73; p < 0.001]. There was no significant difference in the risk of myocardial infarction, stroke, endocarditis or aortic valve re-intervention between the two groups.ConclusionsOur meta-analysis showed that TAVR has similar clinical efficacy to SAVR, with a more favorable safety profile, in patients with severe AS who are at low-surgical risk.Copyright © 2019 Elsevier Inc. All rights reserved.

33 keywords...

hide…