Transcatheter versus surgical aortic valve replacement in intermediate risk patients: A meta-Analysis

Sameer Arora, Jacob A. Misenheimer, Wesley Jones, Amol Bahekar, Melissa Caughey, Cassandra J. Ramm, Thomas G. Caranasos, Michael Yeung, John P. Vavalle

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-Analysis of these studies is required to draw more broad comparisons. Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-Analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). Results: Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)]. Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.

Original languageEnglish (US)
Pages (from-to)241-249
Number of pages9
JournalCardiovascular Diagnosis and Therapy
Volume6
Issue number3
DOIs
StatePublished - Jan 1 2016

Fingerprint

Aortic Valve
Surgical Instruments
Meta-Analysis
Acute Kidney Injury
Myocardial Infarction
Transcatheter Aortic Valve Replacement
Propensity Score
Mortality
Aortic Valve Stenosis
Risk Reduction Behavior
Random Allocation
Observational Studies
Clinical Trials
Prospective Studies
Population

Keywords

  • Aortic stenosis
  • Surgical aortic valve replacement (SAVR)
  • Surgical risk
  • Transcatheter aortic valve replacement (TAVR)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Arora, S., Misenheimer, J. A., Jones, W., Bahekar, A., Caughey, M., Ramm, C. J., ... Vavalle, J. P. (2016). Transcatheter versus surgical aortic valve replacement in intermediate risk patients: A meta-Analysis. Cardiovascular Diagnosis and Therapy, 6(3), 241-249. https://doi.org/10.21037/cdt.2016.03.04

Transcatheter versus surgical aortic valve replacement in intermediate risk patients : A meta-Analysis. / Arora, Sameer; Misenheimer, Jacob A.; Jones, Wesley; Bahekar, Amol; Caughey, Melissa; Ramm, Cassandra J.; Caranasos, Thomas G.; Yeung, Michael; Vavalle, John P.

In: Cardiovascular Diagnosis and Therapy, Vol. 6, No. 3, 01.01.2016, p. 241-249.

Research output: Contribution to journalArticle

Arora, S, Misenheimer, JA, Jones, W, Bahekar, A, Caughey, M, Ramm, CJ, Caranasos, TG, Yeung, M & Vavalle, JP 2016, 'Transcatheter versus surgical aortic valve replacement in intermediate risk patients: A meta-Analysis', Cardiovascular Diagnosis and Therapy, vol. 6, no. 3, pp. 241-249. https://doi.org/10.21037/cdt.2016.03.04
Arora, Sameer ; Misenheimer, Jacob A. ; Jones, Wesley ; Bahekar, Amol ; Caughey, Melissa ; Ramm, Cassandra J. ; Caranasos, Thomas G. ; Yeung, Michael ; Vavalle, John P. / Transcatheter versus surgical aortic valve replacement in intermediate risk patients : A meta-Analysis. In: Cardiovascular Diagnosis and Therapy. 2016 ; Vol. 6, No. 3. pp. 241-249.
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AU - Caughey, Melissa

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