Transcatheter Aortic Valve Replacement vs. Surgical Aortic Valve Replacement for Long-Term Mortality Due to Stroke and Myocardial Infarction: A Meta-Analysis during the COVID-19 Pandemic

Abstract

Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a result of numerous randomized clinical trials comparing surgical aortic valve replacement (SAVR) and TAVR in high- and intermediate-risk patients, showing comparable clinical outcomes and valve hemodynamics. Materials and Methods: An electronic search of Medline, Google Scholar and Cochrane Central was carried out from their inception to 28 September 2022 without any language restrictions. Results: Our meta-analysis demonstrated that, as compared with SAVR, TAVR was not linked with a lower stroke ratio or stroke mortality. It is clear from this that the SAVR intervention techniques applied in the six studies were successful in reducing cardiogenic consequences over time. Conclusions: A significantly decreased rate of mortality from cardiogenic causes was associated with SAVR. Additionally, when TAVR and SAVR were compared for stroke mortality, the results were nonsignificant with a p value of 0.57, indicating that none of these procedures could decrease stroke-related mortality.

The evolution of TAVI performance overtime: an overview of systematic reviews

“…Twenty-four studies out of the thirty-three selected evaluated the risk of stroke. Sixteen studies [ 6 , 8 , 11 , 13 – 16 , 22 , 24 , 26 – 29 , 34 , 36 – 38 ] found the hazard for stroke to be similar between TAVI and SAVR. Two studies [ 9 , 18 ] found TAVI to have a higher rate of stroke than SAVR, with the first study considering only high-risk surgical patients and the second one including patients with all risk classes.…”

“…Four [18,24,27,35] studies found cardiac mortality to be similar between TAVI and SAVR. Two studies [29,36] favored SAVR over TAVI and one [30] reported a lower rate for TAVI in the first year and similar rates in the second year of follow-up. One study [34] reported similar rates in the first year of follow-up, higher rates in the second year for TAVI, and similar rates until year five of follow-up.…”