A Meta-Analysis of Mortality and Major Adverse Cardiovascular and Cerebrovascular Events Following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Panchal, Hemang B.; Ladia, Vatsal; Desai, Saurabh; Shah, Tejaskumar; Ramu, Vijay

doi:10.1016/j.amjcard.2013.05.015

Cited by 54 publications

(27 citation statements)

References 40 publications

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“…Better early mortality in sutureless AVR than TAVI could be elucidated by 2 pieces of evidence, i.e. (1) similar mortality in TAVI and conventional AVR [12][13][14][15][16][17][18][19] and (2) possibly better mortality in sutureless than conventional AVR [20][21][22][23][24][25]. Furthermore, less postoperative paravalvular AR in sutureless AVR than TAVI could bring about better mid-to-long-term survival.…”

Section: Discussionmentioning

confidence: 99%

Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

Takagi

Umemoto

2016

Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

Takagi

Umemoto

2016

Journal of Cardiology

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“…At a mean follow-up of 99 weeks, this was 0.56 in favor of AVR, but this was not significant. Usually, three to six months DAPT was recommended, followed by aspirin [35].…”

Section: Resultsmentioning

confidence: 99%

The Biological Heart Valve in Aortic Position and its Effect on the Brain

Mistiaen¹

2014

CSR

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Thromboembolic events are a major complication of valve replacement. Most of these occur in the brain, with devastating consequences. Biological heart valve prostheses have been designed to reduce these complications as much as possible. This has the advantage that they require less antithrombotic agents compared to mechanical valves. However, thromboembolic events still do occur. The main question is: are such devices thrombogenic on long-term? For this reason, only long-term results have been included. A literature review reveals that there are several sources of emboli: the diseased native valve itself as well as other cardiovascular conditions such as atrial fibrillation or poor left ventricular function. Annual rate of thromboembolism of different series have been compared as well as the effect of several antithrombotic regimens during the first three postoperative months, since this is the most hazardous period. The results of trans-catheter aortic valve implantation have also been added since this is a way to treat patients who cannot stand the trauma of valve surgery. High age and risk scores make comparison with valve surgery difficult however. In either case, the rate of thromboembolism is rather low. Anticoagulation is probably needed within the first three months. If additional risk factors are present, life-long anticoagulation becomes necessary. However, there are some serious limitations in this review. The most important are the lack of standardization of recording embolic events and the value of possible surrogate parameters such as brain lesions on magnetic resonance imaging and cognitive decline. Large scale randomized controlled trials to identify the best antithrombotic protocol are difficult to design: because of confounding patient-related risk factors, large patient number needed to detect significant differences, and large variations in possible combinations of agents. However, every effort should be made to register every event in an adequate and standardized way.

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“…25 In the GARY registry, the mortality of patients with severe aortic insufficiency was 37.5% at 30 days and 50.0% at 1 year. 14 In the FRANCE II registry including 3195 consecutive patients, aortic regurgitation of grade 2 or higher was observed in 15.8% of patients undergoing TAVR and was found to be a strong independent predictor of 1-year mortality for both balloon-expandable (HR,=2.50; P=0.0001) and self-expandable (HR, 2.11; P=0.0001) valves. 25 Patients with a nontransfemoral approach had a much lower risk of postprocedural aortic regurgitation than those treated through a femoral approach.…”

Section: Tavr Leaksmentioning

confidence: 97%

“…13 In another meta-analysis comparing 4659 patients with severe aortic stenosis who underwent TAVR (n=2267) and SAVR (n=2392), 30 14 Because TAVR does not improve survival even in the group of patients considered at the highest risk for surgery, it is unlikely that it will improve survival in younger, low-risk patients. Some rare but potentially lethal complications such as coronary occlusion, annular rupture, ventricular perforation, and vascular injury are procedure related.…”

Section: Tavr Does Not Improve Survival In Operable High-risk Patientsmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement Indications Should Not Be Expanded to Lower-Risk and Younger Patients

Falk

2014

Circulation

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A Meta-Analysis of Mortality and Major Adverse Cardiovascular and Cerebrovascular Events Following Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement for Severe Aortic Stenosis

Cited by 54 publications

References 40 publications

Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

Sutureless aortic valve replacement may improve early mortality compared with transcatheter aortic valve implantation: A meta-analysis of comparative studies

The Biological Heart Valve in Aortic Position and its Effect on the Brain

Transcatheter Aortic Valve Replacement Indications Should Not Be Expanded to Lower-Risk and Younger Patients

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