In patients with degenerated aortic valve bioprostheses, especially elderly or high-risk patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The lack of randomized data and differences in baseline characteristics in the present analysis emphasize the need for prospective randomized trials.

In thoracic aortic surgery, postoperative incidence of stroke and mortality was similar between ACP and RCP, whereas a trend toward a reduction of TND incidence existed in ACP.

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Objectives We sought to determine whether off‐pump coronary artery bypass grafting (CABG) increases long‐term mortality, by performing a meta‐analysis of randomized controlled trials (RCTs) of off‐pump versus on‐pump CABG with ≥5‐year follow‐up. Methods MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long‐term (≥5‐year) mortality for off‐pump versus on‐pump CABG were extracted from each individual trial. Study‐specific estimates were combined using inverse variance‐weighted averages of logarithmic HRs in the random‐effects model. Results Our search identified eight medium‐ to large‐size RCTs at low risk of bias with long‐term follow‐up of off‐pump versus on‐pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on‐pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off‐pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta‐analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off‐pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on‐pump CABG (HR, 1.19; P = 0.05). Conclusions Off‐pump CABG increases long‐term (≥5‐year) mortality compared with on‐pump CABG.

On 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.