Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials
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Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients : a meta-analysis of randomized trials. / Ahmad, Yousif; Howard, James P.; Arnold, Ahran D.; Madhavan, Mahesh V.; Cook, Christopher M.; Alu, Maria; Mack, Michael J.; Reardon, Michael J.; Thourani, Vinod H.; Kapadia, Samir; Thyregod, Hans Gustav Hørsted; Sondergaard, Lars; Jørgensen, Troels Højsgaard; Toff, William D.; Van Mieghem, Nicolas M.; Makkar, Raj R.; Forrest, John K.; Leon, Martin B.
I: European Heart Journal, Bind 44, Nr. 10, 2023, s. 836-852.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients
T2 - a meta-analysis of randomized trials
AU - Ahmad, Yousif
AU - Howard, James P.
AU - Arnold, Ahran D.
AU - Madhavan, Mahesh V.
AU - Cook, Christopher M.
AU - Alu, Maria
AU - Mack, Michael J.
AU - Reardon, Michael J.
AU - Thourani, Vinod H.
AU - Kapadia, Samir
AU - Thyregod, Hans Gustav Hørsted
AU - Sondergaard, Lars
AU - Jørgensen, Troels Højsgaard
AU - Toff, William D.
AU - Van Mieghem, Nicolas M.
AU - Makkar, Raj R.
AU - Forrest, John K.
AU - Leon, Martin B.
N1 - Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2023
Y1 - 2023
N2 - AIMS: Additional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients. METHODS AND RESULTS: The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI. CONCLUSION: In lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.
AB - AIMS: Additional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients. METHODS AND RESULTS: The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI. CONCLUSION: In lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.
KW - Aortic stenosis
KW - Meta-analysis
KW - Surgical aortic valve replacement
KW - Transcatheter aortic valve replacement
U2 - 10.1093/eurheartj/ehac642
DO - 10.1093/eurheartj/ehac642
M3 - Journal article
C2 - 36660821
AN - SCOPUS:85150000947
VL - 44
SP - 836
EP - 852
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 10
ER -
ID: 366765700