Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early Outcomes

Arora, Sameer; Strassle, Paula D.; Ramm, Cassandra J.; Rhodes, Jeremy A.; Vaidya, Smita; Caranasos, Thomas G.; Vavalle, John P.

doi:10.1016/j.hlc.2016.12.003

Cited by 31 publications

(21 citation statements)

References 15 publications

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“…Notably, rates of major stroke were reportedly similar between the two groups, although vascular complications were significantly more frequent in the SAVR group (10). More recently, the results of PARTNER IIA trial and the recent Surgical Replacement and Transcatheter Aortic Valve Implantation (SURTAVI) trials have further cemented the role of TAVR in intermediate-risk patient groups (5,11,12). Our study, which comprised octogenarians with mostly intermediaterisk scores (means STS-PROM of 6.99) demonstrated similar findings to these trials above during a median follow-up of 35 months.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians—surgery still the gold standard?

Hirji¹,

Val²,

Kolkailah³

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Contemporary options for aortic valve replacement (AVR) include transcatheter and surgical approaches (TAVR and SAVR). As evidence accrues for TAVR in high and intermediate risk patients, some clinicians advocate that all patients aged over 80 years should only receive TAVR. Our aim was to investigate the utility of SAVR and minimally invasive AVR (mAVR) among octogenarians in the current era of TAVR. Results: Compared to SAVR patients, TAVR patients were relatively older (86.2 versus 84.2 years) with co-morbidities such as chronic kidney disease (CKD), diabetes mellitus (DM), cerebrovascular disease (CVD), and prior myocardial infarction (MI), all P<0.05. The mean STS-PROM for the TAVR group was statistically higher, 6.81 versus 5.58 for the SAVR group (P<0.001). The median in-hospital LOS was statistically higher for the SAVR group (P<0.05). Cox proportional hazard modeling, adjusted for temporal differences in procedure and patient selection, identified age, New York Heart Association (NYHA) class III/IV, preoperative creatinine, severe chronic lung disease, prior cardiac surgery as significant predictors of decreased survival (all P<0.05), while type of intervention (approach) was non-contributory. Adjusted operative mortality stratified by procedure approaches was similar between full sternotomy SAVR and mAVR, and between alternative access and transfemoral TAVR.Conclusions: After adjusting for confounders, TAVR (regardless of approach), SAVR, and mAVR had comparable operative mortality and mid-term survival. Treatment decisions should be individualized with consensus from a multi-disciplinary heart team, taking into account patient co morbidities, frailty, and quality of life. We believe certain patient groups will still benefit from SAVR even in this elderly population.

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Section: Discussionmentioning

confidence: 98%

Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians—surgery still the gold standard?

Hirji¹,

Val²,

Kolkailah³

et al. 2017

Ann. Cardiothorac. Surg.

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“…TAVI had a pacemaker implantation rate of 41% vs 2.4% in SAVR (p=0.001), and the rate of moderate aortic regurgitation (AR) at 1 and 2 years was 15% vs 1% in the TAVI and SAVR groups, respectively (p=0.001) (figure 1). 10 A recent meta-analysis including the NOTION trial and three propensity-matched cohort studies showed that compared with SAVR, TAVI had a lower risk of 30-day mortality but with wide CIs crossing unity (RR 0.67, 95% CI 0.41 to 1.10) 11. Similar results were observed for stroke (RR 0.60, 95% CI 0.30 to 1.22).…”

Section: What Is the Current Evidence For Tavi In Low-risk Patients?mentioning

confidence: 84%

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Sousa-Uva

2019

Heart

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The median age of patients treated by transcatheter aortic valve implantation (TAVI) is falling across Europe, and low-risk patients with severe aortic stenosis (AS) represent 80% of patients with severe AS undergoing surgical aortic valve replacement (SAVR). There are few data for TAVI in low-risk patients, but there are four ongoing randomised trials of SAVR versus TAVI. The key issues relate to pacemaker implantation rates and the associated potential longer term deleterious effects, and the need to minimise vascular complications and paravalvular leak. Valve leaflet thrombosis and paucity of data on valve durability remain a concern. Given the higher incidence of bicuspid aortic valves in younger patients, outcomes of TAVI in this setting need clarification and are discussed.

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“…This new approval will possibly lead to facing increased complications since more patients will undergo TAVR. Based on this data, new research is coming out concerning for the use of TAVR in low risk patients (13). As these studies come to fruition, with results that show early comparable results between SAVR and TAVR, more procedures will be performed with the side effect of more complications.…”

Section: Aortic Stenosis (As)mentioning

confidence: 99%

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

et al. 2018

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Aortic stenosis (AS) is a common cause of valvular heart disease with heavy disease burden in elderly patients. It is present in almost 7% of patients older than 65. The mortality rate increases significantly once it becomes symptomatic with average life expectancy of around 1-year. Symptoms include angina, syncope, or heart failure. This requires either surgical or transcutaneous replacement. Transcutaneous aortic valve replacement (TAVR) use has increased in recent years from high risk patients to now even including intermediate risk patients. With the increased number of procedures performed, one of the consequences is access site complications. These complications can lead to increased hospitalization, cost, infections, and eventually worse outcomes. In this manuscript, we provide a comprehensive review discussing the consequences, outcomes, frequency, predictors and some possible solutions to these complications set forth in these studies.

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Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Lower Surgical Risk Scores: A Systematic Review and Meta-Analysis of Early Outcomes

Cited by 31 publications

References 15 publications

Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians—surgery still the gold standard?

Outcomes of surgical and transcatheter aortic valve replacement in the octogenarians—surgery still the gold standard?

Transcatheter aortic valve implantation in low-risk patients: is it too early?

Access site complications in transcutaneous aortic valve replacement: frequency, outcomes, prevention, and treatment

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