Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement

Sameer Arora, Satyanarayana R. Vaidya, Paula D. Strassle, Jacob A Misenheimer, Jeremy A. Rhodes, Cassandra J. Ramm, Evan N. Wheeler, Thomas G. Caranasos, Matthew A. Cavender, John P. Vavalle

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. Methods: We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion. Outcomes of interest included 30-day and 1-year mortality, and 30-day complications. If significant heterogeneity was found in the random effects meta-analyses, a sensitivity analysis which individually removed each study was conducted. Results: Seven studies reported results on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions: TF-TAVR is associated with lower 30-day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF-TAVR outcomes.

Original languageEnglish (US)
Pages (from-to)806-812
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume91
Issue number4
DOIs
StatePublished - Mar 1 2018

Fingerprint

Aortic Valve
Surgical Instruments
Meta-Analysis
Mortality
Myocardial Infarction
Propensity Score
Acute Kidney Injury
PubMed
Atrial Fibrillation
Blood Vessels
Cohort Studies
Randomized Controlled Trials
Stroke
Hemorrhage
Costs and Cost Analysis
Incidence
Wounds and Injuries

Keywords

  • TAVR
  • aortic valve replacement
  • myocardial infarction
  • transcatheter
  • transfemoral

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Arora, S., Vaidya, S. R., Strassle, P. D., Misenheimer, J. A., Rhodes, J. A., Ramm, C. J., ... Vavalle, J. P. (2018). Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement. Catheterization and Cardiovascular Interventions, 91(4), 806-812. https://doi.org/10.1002/ccd.27357

Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement. / Arora, Sameer; Vaidya, Satyanarayana R.; Strassle, Paula D.; Misenheimer, Jacob A; Rhodes, Jeremy A.; Ramm, Cassandra J.; Wheeler, Evan N.; Caranasos, Thomas G.; Cavender, Matthew A.; Vavalle, John P.

In: Catheterization and Cardiovascular Interventions, Vol. 91, No. 4, 01.03.2018, p. 806-812.

Research output: Contribution to journalArticle

Arora, S, Vaidya, SR, Strassle, PD, Misenheimer, JA, Rhodes, JA, Ramm, CJ, Wheeler, EN, Caranasos, TG, Cavender, MA & Vavalle, JP 2018, 'Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement', Catheterization and Cardiovascular Interventions, vol. 91, no. 4, pp. 806-812. https://doi.org/10.1002/ccd.27357
Arora S, Vaidya SR, Strassle PD, Misenheimer JA, Rhodes JA, Ramm CJ et al. Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement. Catheterization and Cardiovascular Interventions. 2018 Mar 1;91(4):806-812. https://doi.org/10.1002/ccd.27357
Arora, Sameer ; Vaidya, Satyanarayana R. ; Strassle, Paula D. ; Misenheimer, Jacob A ; Rhodes, Jeremy A. ; Ramm, Cassandra J. ; Wheeler, Evan N. ; Caranasos, Thomas G. ; Cavender, Matthew A. ; Vavalle, John P. / Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement. In: Catheterization and Cardiovascular Interventions. 2018 ; Vol. 91, No. 4. pp. 806-812.
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AU - Vaidya, Satyanarayana R.

AU - Strassle, Paula D.

AU - Misenheimer, Jacob A

AU - Rhodes, Jeremy A.

AU - Ramm, Cassandra J.

AU - Wheeler, Evan N.

AU - Caranasos, Thomas G.

AU - Cavender, Matthew A.

AU - Vavalle, John P.

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N2 - Background: In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. Methods: We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion. Outcomes of interest included 30-day and 1-year mortality, and 30-day complications. If significant heterogeneity was found in the random effects meta-analyses, a sensitivity analysis which individually removed each study was conducted. Results: Seven studies reported results on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions: TF-TAVR is associated with lower 30-day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF-TAVR outcomes.

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