Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: A meta‐analysis of randomized trials and propensity score matched observational studies

Witberg, Guy; Lador, Adi; Yahav, Dafna; Kornowski, Ran

doi:10.1002/ccd.27518

Cited by 45 publications

(35 citation statements)

References 28 publications

(58 reference statements)

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“…Surgical aortic valve replacement (SAVR) was once the only treatment for severe aortic stenosis, but it was often contraindicated in elderly patients because of their age, the severity of aortic stenosis, and comorbidities [3]. Data from developed countries have shown that about one-third of patients with severe aortic stenosis are unable to undergo surgical thoracotomy because of their high surgical risk, or because of contraindications to surgery and anesthesia [4,5].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Zhou

Yang³

et al. 2019

Med Sci Monit

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Departmental sources Background: Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. Material/Methods: PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. Results: Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). Conclusions: Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.

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Section: Introductionmentioning

confidence: 99%

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Zhou

Yang³

et al. 2019

Med Sci Monit

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“…Improvements in TAVR device design, delivery systems and operator experience have led to increasing adoption of TAVR in low-risk patient populations [6,11]. Despite a lack of supporting clinical data, it is conceivable that a less invasive transcatheter approach may provide a safe and effective alternative to SAVR.…”

Section: Discussionmentioning

confidence: 99%

“…To date, registry data examining low-risk patients undergoing TAVR has demonstrated mixed results [6]. A prior meta-analysis comparing TAVR and SAVR in this population suggested a higher 2-year mortality-rate following TAVR, despite similar short-term outcomes [6].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

Koshy

Murphy

Farouque

et al. 2020

Heart, Lung and Circulation

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“…LVEF improvement seems to be the same between TAVI and SAVR; but in patients with low baseline LVEF (< 40%) the improvement may be grater after TAVI than after SAVR. Witberg et al [15] made a systematic review and meta-analysis on the relative risks and benefits of TAVR vs. SAVR in patients who are at low surgical risk. TAVI and SAVR resulted equivalent in short-term mortality but, in intermediate term mortality, TAVI showed increasing mortality rates compared to SAVR suggesting that TAVI should not be performed in this population.…”

Section: Discussionmentioning

confidence: 99%

Bridging aortic valve surgery to 21st century: what can a surgeon do?

D'Abramo¹,

Ferrante²,

Guimarães³

et al. 2019

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Aortic valve stenosis is the most clinically relevant valvular heart disease in the elderlies. Surgical aortic valve replacement (SAVR) represented, for decades, the standard of care for the treatment of severe aortic stenosis. Although SAVR still represents a valid option in this clinical scenario, transcatheter aortic valve implantation proved to be superior to medical therapy and comparable to SAVR in several randomized trials in patients at high or intermediate operative risk. At the same time, the growing aging population carrying on greater morbidities and high risk profiles has led to the development of minimally invasive technologies, as rapid deployment aortic valve replacement or Sutureless, to minimize surgical impact on patients. The Heart Team is nowadays tasked to determine the best option tailored for each patient considering patient-related factors and mastering all the surgical options in terms of both different techniques and types of available valves. Nevertheless, some open issues need to be already answered as: which has the longest durability, which the lower complication rate and the lower overall mortality. The aim of this review is to briefly resume the main features of these different options and explore what kind of open questions these newer-generation prosthetic valves and delivery devices carry.

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Transcatheter versus surgical aortic valve replacement in patients at low surgical risk: A meta‐analysis of randomized trials and propensity score matched observational studies

Abstract: In patients who are at low surgical risk, TAVR seems to be associated with increased mortality risk. Until more data in this population is available, SAVR should remain the treatment of choice for these patients.

Cited by 45 publications

References 28 publications

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

Bridging aortic valve surgery to 21st century: what can a surgeon do?

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