Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management

Sattar, Yasar; Rauf, Hiba; Bareeqa, Syeda Beenish; Ullah, Waqas; Myla, Madhura

doi:10.7759/cureus.6431

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…Studies were eligible for inclusion if they met the following criteria: (1) RCTs or observational studies; (2) patients with aortic stenosis or regurgitation undergoing TAVR; (3) comparative study of different antithrombotic strategies post-TAVR including DAPT, SAPT; (4) reported at least one adverse event (such as death, myocardial infarction, stroke, and bleeding); and (5) articles published in English. Study titles and abstracts were reviewed for eligibility by two independent investigators (YZ and WY), and studies that satisfied the inclusion criteria were retrieved for full-text assessment.…”

Section: Study Selection and Data Extractionmentioning

confidence: 99%

“…Transcatheter aortic valve replacement (TAVR) has emerged as an effective and alternative therapeutic strategy for patients with severe symptomatic aortic valve stenosis, especially for those with intermediate or high surgical risk of surgical aortic valve replacement (SAVR) (1,2). Despite its high procedure success rate and non-inferiority efficacy to SAVR, TAVR has been associated with severe major adverse cardiac and cerebrovascular complications such as mortality, myocardial infarction (MI), major stroke, life-threatening bleeding (LTB), and major vascular complication (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

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Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis

Zhang

Shen

Yang

et al. 2021

Front. Cardiovasc. Med.

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Background: Although mainstream guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in patients following transcatheter aortic valve replacement (TAVR), it is not evidence-based. We aim to investigate the safety and efficacy of DAPT vs. single antiplatelet therapy (SAPT) after TAVR, and review updated evidence.Methods: We systematically searched PubMed, Embase, and Cochrane for studies comparing DAPT to SAPT after TAVR from inception to November 30, 2020. The primary outcome was major adverse cardiac and cerebrovascular events, including all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and major or life-threatening bleeding (LTB). Subgroup analysis was performed according to study type (randomized control trials vs. observational studies) using a fixed-effects model. The quality of evidence was assessed by two scoring systems and GRADE (Grading of Recommendations Assessment, Development, and Evaluation).Results: Twelve studies of 20,766 patients were included in our meta-analysis. Compared with SAPT, DAPT was associated with an increased risk for combined life threatening and major bleeding [OR 1.73 (1.19–2.51), p = 0.004] after TAVR. Such a difference was largely driven by major bleeding [OR 2.29 (1.68–3.11), p < 0.001]. There were no significant differences on major adverse cardiovascular events (MACE) [OR 1.19 (0.99–1.44), p = 0.07], cardiovascular mortality [OR 1.46 (0.93–2.30), p = 0.10], and stroke [OR 0.97 (0.80–1.16), p = 0.71].Conclusions: Compared with SAPT, post-TAVR DAPT was associated with increased risks of major or life-threatening bleeding without additional benefits of reducing thrombotic events. Future guidelines for post-TAVR antiplatelet strategy are expected to be updated as new high-quality evidence emerges.Systematic Review Registration: PROSPERO, Identifier: CRD42021230075.

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Section: Study Selection and Data Extractionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis

Zhang

Shen

Yang

et al. 2021

Front. Cardiovasc. Med.

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“…Interventional treatment of aortic stenosis is currently based on two different approaches: transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR) [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis

Palo¹,

Scicchitano²,

Malvindi

et al. 2021

Antibiotics

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The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).

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“…Durch die vermehrte Druckbelastung des linken Ventrikels kommt es zur Linksherzhypertrophie. [1] Die Vorteile einer TAVI liegen auf der Hand: Sie kann meist ohne Vollnarkose in Analgosedierung mit Lokalanästhesie erfolgen, verzichtet auf den extrakorporalen Kreislauf (den Anschluss des Patienten an die Herz-Lungen-Maschine), auf die Eröffnung des Brustkorbs -die Sternotomie. Konventionell möglich ist auch ein Klappenersatz über eine partielle Sternotomie und minimalinvasiv über eine rechtsseitige anterior-laterale Thorakotomie (RALT).…”

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Transkatheter-Aortenklappenimplantation – perkutan über die Leiste

Jankwitz¹

2021

Im OP

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Vor fast 20 Jahren wurde sie erstmal durchgeführt: die Transkatheter-Aortenklappenimplantation (englisch: Transcatheter Aortic Valve Implantation; kurz TAVI). Durch das innovative OP-Verfahren können Patienten, die bei einer diagnostizierten Aortenklappenstenose aufgrund ihrer Vorerkrankungen bis dato als inoperabel galten, eine neue Herzklappe bekommen. Wie die OP abläuft und was dabei beachtet werden muss, erläutert unsere Autorin anhand des Hausstandards des Deutschen Herzzentrums Berlin.

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Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management

Cited by 7 publications

References 33 publications

Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis

Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis

Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis

Transkatheter-Aortenklappenimplantation – perkutan über die Leiste

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