Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement

Shah, Kuldeep; Chaker, Zakeih; Busu, Tatiana; Badhwar, Vinay; Alqahtani, Fahad; Alvi, Muhammad; Adcock, Amelia; Alkhouli, Mohamad

doi:10.1016/j.amjcard.2018.06.032

Cited by 13 publications

(11 citation statements)

References 34 publications

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“…The outcome of stroke had the highest level of heterogeneity among the systematic reviews, with the majority of studies reporting no difference between TAVR and SAVR. These results were confirmed by a recent meta-analysis comparing the frequency of stroke after TAVR versus SAVR [ 30 ], where no difference in the incidence of stroke risk at 30 days and after one year was reported in a subgroup analysis of low-to-intermediate risk patients.…”

Section: Discussionsupporting

confidence: 66%

Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: An overview of reviews

Morrow¹,

Kriza²,

Urban³

et al. 2020

International Journal of Cardiology

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Background Transcatheter aortic valve replacement (TAVR) was initially introduced to treat patients with aortic valve stenosis (AS) at high-risk for surgical aortic valve replacement (SAVR). Today, there is ample evidence supporting TAVR in high-risk groups. However, in recent years TAVR has been extended to low-to intermediate risk groups and relevant clinical evidence is still emerging, leaving some uncertainties. Methods To obtain information on TAVR versus SAVR in low-to intermediate risk groups, we conducted an overview of systematic reviews following PRISMA guidelines and based on a systematic search of EMBASE, MEDLINE, Cochrane and CRD databases. We focused on systematic reviews assessing mortality and VARC 2 as clinical outcomes. Results The majority of the 11 systematic reviews included in our study reported no differences in mortality between TAVR and SAVR at short and long-term follow-up times. Two reviews that included the most recent RCTs on low-risk patients reported a decreased mortality risk with TAVR at one-year follow-up. Regarding the secondary endpoints of stroke and MI, the majority of studies presented similar results for TAVR and SAVR. Acute Kidney Injury, Bleeding Complications, Atrial Fibrillation were less frequent with TAVR, with lower risk of Permanent Pacemaker Implantation and Aortic Regurgitation with SAVR. Conclusions Our overview indicated that TAVR is a promising intervention for low-to-intermediate surgical risk patients; however additional evidence from longer term follow-up is needed to confirm these findings. This overview highlights inconsistencies about reporting and presentation of data, most notably limited clarity on effects of risk of bias on trial results.

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Section: Discussionsupporting

confidence: 66%

Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: An overview of reviews

Morrow¹,

Kriza²,

Urban³

et al. 2020

International Journal of Cardiology

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“…The endpoint of interest in this study is renal outcomes which were not described in our previous papers making this study unique. [5, 6]…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical Aortic Valve Replacement

Shah¹,

Chaker²,

Busu³

et al. 2019

Journal of Interventional Cardiology

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Background. Acute kidney injury (AKI) is a common complication of aortic valve replacement. However, comparative on the incidence of (AKI) following transcatheter (TAVR) versus surgical valve replacement (SAVR) is sparse. Methods. We performed a meta-analysis of the randomized controlled trials (RCT) and propensity-matched observational studies comparing (A) incidence of AKI and (B) incidence of dialysis-requiring AKI at 30 days after TAVR and SAVR. Results. Twenty-six studies (20 propensity-matched studies; 6 RCTs) including 19,954 patients were analyzed. The incidence of AKI was lower after TAVR than after SAVR (7.1% vs. 12.1%, OR 0.52; 95%CI, 0.39-0.68; p<0.001, I2=57%), but the incidence of dialysis-requiring AKI was similar (2.8% vs. 4.1%, OR 0.78; 95%CI, 0.49-1.25; p=0.31, I2=70%). Similar results were observed in a sensitivity analysis including RCTs only for both AKI ([5 RCTs; 5,418 patients], 2.0% vs. 5.0%, OR 0.39; 95%CI, 0.28-0.53; p<0.001, I2=0%), and dialysis-requiring AKI ([2 RCTs; 769 patients]; 2.9% vs. 2.6%, OR 1.1; 95%CI, 0.47-2.58; p=0.83, I2=0%). However, in studies including low-intermediate risk patients only, TAVR was associated with lower incidence of AKI ([10 studies; 6,510 patients], 7.6% vs. 12.4%, OR 0.55, 95%CI 0.39-0.77, p<0.001, I2=57%), and dialysis-requiring AKI, ([10 studies; 12,034 patients], 2.0% vs. 3.6%, OR 0.57, 95%CI 0.38-0.85, p=0.005, I2=23%). Conclusions. TAVR is associated with better renal outcomes at 30 days in comparison with SAVR, especially in patients at low-intermediate surgical risk. Further studies are needed to assess the impact of AKI on long-term outcomes of patients undergoing TAVR and SAVR.

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“…The incidence of periprocedural stroke after TAVR and SAVR has been reported to be as high as 10% in studies with careful neurological examination 8,9 . Previous meta‐analyses have shown comparable risks of stroke at 30 days and 1‐year between TAVR and SAVR in high‐ or intermediate‐risk patients, 10,11 but none of these reports included recently published low‐risk studies 1,2,12‐14 . Importantly, the risk of stroke between TAVR and SAVR has not been assessed with respect to the individual surgical risk thus far.…”

Section: Introductionmentioning

confidence: 99%

Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis

Matsuda

Fovino

Giacoppo

et al. 2020

Cathet Cardio Intervent

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Background Stroke is a feared complication of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Objectives With this meta‐analysis we aimed to evaluate the incidence of 30‐day stroke with TAVR and SAVR focusing on its possible correlation with surgical risk. Methods Major electronic databases were searched for studies published between January 2002 and October 2019 reporting the rates of 30‐day stroke after TAVR and SAVR. Data were pooled using fixed‐ and random‐effects models. The primary outcome of the study was stroke rate within 30‐day from TAVR or SAVR. Results were stratified according to surgical risk score (high, intermediate and low). Results A total of 23 studies were identified (TAVR: 14,589 patients; SAVR: 11,681 patients). Regardless of the model used, in the overall population TAVR was associated with a significant reduction in the risk of stroke compared with SAVR (fixed effect: OR 0.78, 95% CI 0.66–0.92, p = .003; random‐effects: OR 0.80, 95% CI 0.64–1.00, p = .045). Rates of 30‐day stroke after TAVR and SAVR were not significantly different in the high‐ (OR 1.01, 95% CI 0.44–1.98, p = .105) and intermediate‐risk groups (OR 0.92, 95% CI 0.63–1.36, p = .319), while low‐risk patients had a lower rate of 30‐day stroke after TAVR than SAVR (OR 0.65, 95% CI 0.50–0.83, p < .001). Meta‐regression showed a significant association between surgical risk score and 30‐day stroke rate (p = .007). Conclusions TAVR is associated with a lower risk of 30‐day stroke compared with SAVR, mainly as a result of the significant advantage observed in patients at low surgical risk.

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Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement

Cited by 13 publications

References 34 publications

Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: An overview of reviews

Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: An overview of reviews

Meta-Analysis Comparing Renal Outcomes after Transcatheter versus Surgical Aortic Valve Replacement

Association between surgical risk and 30‐day stroke after transcatheter versus surgical aortic valve replacement: a systematic review and meta‐analysis

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