Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

Chen, Kai

Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients: A Meta-Analysis of Randomized Controlled Trials and Observational Studies

Wednesday, May 22, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Kai Chen , University of Miami Palm Beach Regional Campus, Atlantis, FL

Jesus E. Pino, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Abdulah Alrifai , University of Miami Palm Beach Regional Campus, Atlantis, FL

Mohamad Kabach , University of Miami Palm Beach Regional Campus, Atlantis, FL

Elie Donath, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Robert Chait, M.D. , University of Miami Palm Beach Regional Campus, Atlantis, FL

Background:
Transcatheter aortic valve replacement (TAVR) is an effective treatment for patients with severe aortic stenosis at intermediate to high surgical risk. The use of TAVR in low risk patients is also on the rise. However, the efficacy and safety profile in this population is still unclear.

Methods:
We conducted a meta-analysis of both randomized controlled trials (RCTs) and observational studies comparing TAVR and surgical aortic valve replacement (SAVR) in low surgical risk patients. Comprehensive and systematic search of PubMed, Scopus and Embase was performed. 3 RCTs and 5 observational studies were included. The primary outcomes are 30-day mortality, 1-year mortality, and periprocedural complications.

Results:
Total of 4657 patients were included in eight studies with follow up between 3 months to 3 years. The 30-day mortality was similar between TAVR and SAVR, (RR 0.86, 95% CI 0.55-1.34) using fixed effect model. The 1-year mortality was significantly higher in TAVR than SAVR, (RR 1.30, 95% CI 1.04-1.61). Patients underwent TAVR had less acute kidney injury (RR 0.34, 95% CI 0.24-0.49) and major bleeding (RR 0.47, 95% CI 0.37-0.59), more pacemaker implantation (RR 4.22, 95% CI 3.25-5.47) and vascular complications (RR 12.11, 95% CI 6.28-23.34). There was no significant difference between cerebrovascular accident (RR 0.76, 95% CI 0.47-1.24) or myocardial infarction (RR 0.60, 95% CI 0.27-1.32).

Conclusions:
Among lower surgical risk patients, TAVR appear to have higher 1-year mortality. More studies are needed to further investigate long term outcomes in this population.