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Transcatheter versus surgical aortic valve replacement in low- and intermediate-risk patients: an updated systematic review and meta-analysis

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Abstract

Transcatheter aortic valve replacement (TAVR) has been recognized as a well-established alternative to surgical aortic valve replacement (SAVR) for symptomatic aortic stenosis with high surgical risk. With this updated systematic review and meta-analysis, we evaluated TAVR vs. SAVR in low- and intermediate-risk subjects. Studies comparing TAVR and SAVR in low-risk patients (defined as STS ≤ 8% or EuroSCORE ≤ 20%) were identified with electronic searches. The principal endpoint was all-cause mortality at short term (< 3 months), 1, and 2 years. Other outcomes of interest were cardiac mortality, neurological events, paravalvular leakage (PVL), myocardial infarction (MI), major bleeding, acute kidney injury (AKI), vascular complications, and new pacemaker (PM) implantation. Seventeen articles including 9805 (4956 TAVR and 4849 SAVR) patients were eligible. There was no significant difference in all-cause mortality at short term [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.63–1.09], 1 year (OR 1.01, 95% CI 0.86–1.20) and 2 years (OR 0.86, 95% CI 0.64–1.16) between treatment groups. Subgroup analyses stratified by surgical risk score (low-risk subgroup: STS < 4% or EuroSCORE < 10%, intermediate-risk subgroup: the others) did not show interaction on primary endpoints. Compared to SAVR, TAVR had similar rates of neurological events, significantly lower risk of MI and AKI, but higher risk of vascular complications, new PM implantation and moderate/severe PVL. In low- and intermediate-risk patients, TAVR and SAVR have similar short- and mid-term all-cause mortality. Compared to SAVR, TAVR carries higher rates of vascular complications, PM implantation and moderate/severe PVL, but lower risk of MI and AKI.

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Author notes

  1. Daisuke Ueshima and Luca Nai Fovino contributed equally to this work.

Authors and Affiliations

  1. Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy

    Daisuke Ueshima, Luca Nai Fovino, Gianpiero D’Amico & Giuseppe Tarantini

  2. Department of Medicine, Cardiac Catheterization Laboratory, New York Methodist Hospital, New York, USA

    Sorin J. Brener

  3. Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy

    Giovanni Esposito

  4. Clinica Cardiologica, Ospedale di Padova, Centro Cardiologico Gallucci, Via Giustiniani, 2, 35128, Padua, Italy

    Giuseppe Tarantini

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  1. Daisuke Ueshima
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  2. Luca Nai Fovino
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  3. Gianpiero D’Amico
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Correspondence to Giuseppe Tarantini.

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G Tarantini received lecture fees from Edwards Lifesciences, Medtronic and Boston Scientifics. The other authors have no relevant conflict of interest to disclose.

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Ueshima, D., Fovino, L.N., D’Amico, G. et al. Transcatheter versus surgical aortic valve replacement in low- and intermediate-risk patients: an updated systematic review and meta-analysis. Cardiovasc Interv and Ther 34, 216–225 (2019). https://doi.org/10.1007/s12928-018-0546-5

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