OR07-6
The Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Pure Aortic Regurgitation: A Systematic Review and Meta-analysis
Bo Peng, MD., PhD., Washington State University, Everett, WA
Bo Peng, MD., PhD.1, Jonah-Imee R Talavera-Paragas, MD.1, Ava Gharai1 and Apurva Badheka, MD.2, (1)Washington State University, Everett, WA, (2)The Everett Clinic, Everett, WA
Keywords: Complications and TAVI/TAVR/Aortic Valve
Background:
Surgical aortic valve replacement (SAVR) is the current treatment of choice for severe pure aortic regurgitation (AR). Transcatheter aortic valve replacement (TAVR) has been applied in patients with high operation risks. We aim to compare the characteristics and short-term outcomes of TAVR vs. SAVR for pure AR. Methods:
Studies on MEDLINE, CINAHL, Web of Science, Embase, and Cochrane that compare the outcomes of TAVR vs. SAVR for pure AR were obtained. Baseline characteristics and short-term outcomes were presented with odd ratio (OR) and 95% confidence intervals (CI), and heterogeneity was presented with I2. Results:
Five studies were included containing 3,037 and 27,131 patients who received TAVR and SAVR, respectively. The majority of patients are male (64.1% received TAVR and 60.6% received SAVR). Compared to SAVR, patients who underwent TAVR have higher incidences of pre-existing coronary artery disease (OR=2.169, 95% CI 1.091 to 4.311, I2=98.25%), congestive heart failure (OR=3.778, 95% CI 2.527 to 4.311, I2=93.95%), chronic kidney disease (OR=1.858, 95% CI 1.013 to 3.408, I2=96.47%), and diabetes mellitus (OR=1.670, 95% CI 1.500 to 1.860, I2=20.7%) without significant differences in pre-existing atrial fibrillation (OR=1.274, 95% CI 0.910 to 1.783, I2=83.13%) or hypertension (OR=0.804, 95% CI 0.439 to 1.472, I2=96.9%). A significantly lower in-hospital mortality (OR=0.751, 95% CI 0.591 to 0.955, I2=0%) was observed in the TAVR group compared to the SAVR group. No significant differences in post-procedural acute kidney injury (OR=2.709, 95% CI 0.718 to 10.215, I2=97.79%), major bleeding (OR=0.730, 95% CI 0.158 to 3.372, I2=97.59%), or stroke (OR=0.750, 95% CI 0.358 to 1.571, I2=80.71%) was observed. Noticeably, TAVR leads to an increased risk of new pacemaker placement compared to SAVR (OR= 2.030, 95% CI 1.547 to 2.663, I2=63.49%). Conclusions:
Our study suggests, with limited evidence, that despite increased incidences of certain pre-existing comorbidities, patients who received TAVR for pure AR may have a lower in-hospital mortality and comparable major complications compared to the current treatment of choice SAVR, which warrants further validation.