Advertisement

Meta-Analysis of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis

Published:November 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.10.034
      Transcatheter aortic valve replacement (TAVR) is a viable option in the treatment of severe aortic stenosis in patients at high risk for surgery. We sought to further investigate outcomes in patients at low to intermediate risk with aortic stenosis who underwent surgical aortic valve replacement (SAVR) versus TAVR. We systematically searched the electronic databases, MEDLINE, PubMed, EMBASE, and Cochrane for prospective cohort studies of the effects of TAVR versus SAVR on clinical outcomes (30-day mortality, all-cause mortality, stroke and myocardial infarction, major vascular complications, paravalvular regurgitation, permanent pacemaker implantation, major bleeding, and acute kidney injury). We identified 5 clinical studies, examining 1,618 patients in the TAVR group and 1,581 patients in the SAVR group with an average follow-up of 1.05 years. No difference in all-cause mortality, stroke, and myocardial infarction between the 2 approaches was found. TAVR was associated with higher rates of vascular complications, permanent pacemaker implantation, and moderate or severe paravalvular regurgitation (p <0.001 for all), whereas more major bleeding events were seen in the SAVR group (p <0.001). In conclusion, TAVR was found to have similar survival and stroke rates and lower major bleeding rates as compared with SAVR in patients at low or intermediate surgical risk. However, SAVR was associated with less pacemaker placements and paravalvular regurgitation rates.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kelly T.A.
        • Rothbart R.M.
        • Cooper C.M.
        • Kaiser D.L.
        • Smucker M.L.
        • Gibson R.S.
        Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis.
        Am J Cardiol. 1988; 61: 123-130
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin 3rd, J.P.
        • Guyton R.A.
        • O'Gara P.T.
        • Ruiz C.E.
        • Skubas N.J.
        • Sorajja P.
        • Sundt 3rd, T.M.
        • Thomas J.D.
        2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2014; 63: 2438-2488
        • Schwarz F.
        • Baumann P.
        • Manthey J.
        • Hoffmann M.
        • Schuler G.
        • Mehmel H.C.
        • Schmitz W.
        • Kubler W.
        The effect of aortic valve replacement on survival.
        Circulation. 1982; 66: 1105-1110
        • Thourani V.H.
        • Ailawadi G.
        • Szeto W.Y.
        • Dewey T.M.
        • Guyton R.A.
        • Mack M.J.
        • Kron I.L.
        • Kilgo P.
        • Bavaria J.E.
        Outcomes of surgical aortic valve replacement in high-risk patients: a multiinstitutional study.
        Ann Thorac Surg. 2011; 91: 49-55
        • Panchal H.B.
        • Ladia V.
        • Desai S.
        • Shah T.
        • Ramu V.
        A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis.
        Am J Cardiol. 2013; 112: 850-860
        • Mack M.J.
        • Leon M.B.
        • Smith C.R.
        • Miller D.C.
        • Moses J.W.
        • Tuzcu E.M.
        • Webb J.G.
        • Douglas P.S.
        • Anderson W.N.
        • Blackstone E.H.
        • Kodali S.K.
        • Makkar R.R.
        • Fontana G.P.
        • Kapadia S.
        • Bavaria J.
        • Hahn R.T.
        • Thourani V.H.
        • Babaliaros V.
        • Pichard A.
        • Herrmann H.C.
        • Brown D.L.
        • Williams M.
        • Akin J.
        • Davidson M.J.
        • Svensson L.G.
        5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial.
        Lancet. 2015; 385: 2477-2484
        • Lange R.
        • Bleiziffer S.
        • Mazzitelli D.
        • Elhmidi Y.
        • Opitz A.
        • Krane M.
        • Deutsch M.A.
        • Ruge H.
        • Brockmann G.
        • Voss B.
        • Schreiber C.
        • Tassani P.
        • Piazza N.
        Improvements in transcatheter aortic valve implantation outcomes in lower surgical risk patients: a glimpse into the future.
        J Am Coll Cardiol. 2012; 59: 280-287
        • Wenaweser P.
        • Stortecky S.
        • Schwander S.
        • Heg D.
        • Huber C.
        • Pilgrim T.
        • Gloekler S.
        • O'Sullivan C.J.
        • Meier B.
        • Juni P.
        • Carrel T.
        • Windecker S.
        Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation.
        Eur Heart J. 2013; 34: 1894-1905
        • Latib A.
        • Maisano F.
        • Bertoldi L.
        • Giacomini A.
        • Shannon J.
        • Cioni M.
        • Ielasi A.
        • Figini F.
        • Tagaki K.
        • Franco A.
        • Covello R.D.
        • Grimaldi A.
        • Spagnolo P.
        • Buchannan G.L.
        • Carlino M.
        • Chieffo A.
        • Montorfano M.
        • Alfieri O.
        • Colombo A.
        Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score-matched case-control study.
        Am Heart J. 2012; 164: 910-917
        • Tamburino C.
        • Barbanti M.
        • D'Errigo P.
        • Ranucci M.
        • Onorati F.
        • Covello R.D.
        • Santini F.
        • Rosato S.
        • Santoro G.
        • Fusco D.
        • Grossi C.
        • Seccareccia F.
        • OBSERVANT Research Group
        1-Year outcomes after transfemoral transcatheter or surgical aortic valve replacement: results from the Italian OBSERVANT study.
        J Am Coll Cardiol. 2015; 66: 804-812
        • Piazza N.
        • Kalesan B.
        • van Mieghem N.
        • Head S.
        • Wenaweser P.
        • Carrel T.P.
        • Bleiziffer S.
        • de Jaegere P.P.
        • Gahl B.
        • Anderson R.H.
        • Kappetein A.P.
        • Lange R.
        • Serruys P.W.
        • Windecker S.
        • Juni P.
        A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients.
        JACC Cardiovasc Interv. 2013; 6: 443-451
        • Thyregod H.G.
        • Steinbruchel D.A.
        • Ihlemann N.
        • Nissen H.
        • Kjeldsen B.J.
        • Petursson P.
        • Chang Y.
        • Franzen O.W.
        • Engstrom T.
        • Clemmensen P.
        • Hansen P.B.
        • Andersen L.W.
        • Olsen P.S.
        • Sondergaard L.
        Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-Year results from the all-Comers NOTION randomized clinical trial.
        J Am Coll Cardiol. 2015; 65: 2184-2194
        • Nielsen H.H.
        • Klaaborg K.E.
        • Nissen H.
        • Terp K.
        • Mortensen P.E.
        • Kjeldsen B.J.
        • Jakobsen C.J.
        • Andersen H.R.
        • Egeblad H.
        • Krusell L.R.
        • Thuesen L.
        • Hjortdal V.E.
        A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial.
        EuroIntervention. 2012; 8: 383-389
        • O'Brien S.M.
        • Shahian D.M.
        • Filardo G.
        • Ferraris V.A.
        • Haan C.K.
        • Rich J.B.
        • Normand S.L.
        • DeLong E.R.
        • Shewan C.M.
        • Dokholyan R.S.
        • Peterson E.D.
        • Edwards F.H.
        • Anderson R.P.
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 2–isolated valve surgery.
        Ann Thorac Surg. 2009; 88: S23-42
        • Leon M.B.
        • Piazza N.
        • Nikolsky E.
        • Blackstone E.H.
        • Cutlip D.E.
        • Kappetein A.P.
        • Krucoff M.W.
        • Mack M.
        • Mehran R.
        • Miller C.
        • Morel M.A.
        • Petersen J.
        • Popma J.J.
        • Takkenberg J.J.
        • Vahanian A.
        • van Es G.A.
        • Vranckx P.
        • Webb J.G.
        • Windecker S.
        • Serruys P.W.
        Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium.
        J Am Coll Cardiol. 2011; 57: 253-269
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gotzsche P.C.
        • Ioannidis J.P.
        • Clarke M.
        • Devereaux P.J.
        • Kleijnen J.
        • Moher D.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Sterne J.A.
        • Egger M.
        • Smith G.D.
        Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis.
        BMJ. 2001; 323: 101-105
        • Reardon M.J.
        • Adams D.H.
        • Kleiman N.S.
        • Yakubov S.J.
        • Coselli J.S.
        • Deeb G.M.
        • Gleason T.G.
        • Lee J.S.
        • Hermiller Jr., J.B.
        • Chetcuti S.
        • Heiser J.
        • Merhi W.
        • Zorn 3rd, G.L.
        • Tadros P.
        • Robinson N.
        • Petrossian G.
        • Hughes G.C.
        • Harrison J.K.
        • Maini B.
        • Mumtaz M.
        • Conte J.V.
        • Resar J.R.
        • Aharonian V.
        • Pfeffer T.
        • Oh J.K.
        • Qiao H.
        • Popma J.J.
        2-Year outcomes in patients undergoing surgical or self-expanding transcatheter aortic valve replacement.
        J Am Coll Cardiol. 2015; 66: 113-121
        • Leon M.B.
        • Smith C.R.
        • Mack M.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • Tuzcu E.M.
        • Webb J.G.
        • Fontana G.P.
        • Makkar R.R.
        • Brown D.L.
        • Block P.C.
        • Guyton R.A.
        • Pichard A.D.
        • Bavaria J.E.
        • Herrmann H.C.
        • Douglas P.S.
        • Petersen J.L.
        • Akin J.J.
        • Anderson W.N.
        • Wang D.
        • Pocock S.
        • Partner Trial Investigators
        Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.
        N Engl J Med. 2010; 363: 1597-1607
        • Smith C.R.
        • Leon M.B.
        • Mack M.J.
        • Miller D.C.
        • Moses J.W.
        • Svensson L.G.
        • Tuzcu E.M.
        • Webb J.G.
        • Fontana G.P.
        • Makkar R.R.
        • Williams M.
        • Dewey T.
        • Kapadia S.
        • Babaliaros V.
        • Thourani V.H.
        • Corso P.
        • Pichard A.D.
        • Bavaria J.E.
        • Herrmann H.C.
        • Akin J.J.
        • Anderson W.N.
        • Wang D.
        • Pocock S.J.
        • Partner Trial Investigators
        Transcatheter versus surgical aortic-valve replacement in high-risk patients.
        N Engl J Med. 2011; 364: 2187-2198
        • Abdel-Wahab M.
        • Mehilli J.
        • Frerker C.
        • Neumann F.J.
        • Kurz T.
        • Tolg R.
        • Zachow D.
        • Guerra E.
        • Massberg S.
        • Schafer U.
        • El-Mawardy M.
        • Richardt G.
        • CHOICE Investigators
        Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial.
        JAMA. 2014; 311: 1503-1514
        • Detaint D.
        • Lepage L.
        • Himbert D.
        • Brochet E.
        • Messika-Zeitoun D.
        • Iung B.
        • Vahanian A.
        Determinants of significant paravalvular regurgitation after transcatheter aortic valve: implantation impact of device and annulus discongruence.
        JACC Cardiovasc Interv. 2009; 2: 821-827
        • Koos R.
        • Mahnken A.H.
        • Aktug O.
        • Dohmen G.
        • Autschbach R.
        • Marx N.
        • Hoffmann R.
        Electrocardiographic and imaging predictors for permanent pacemaker requirement after transcatheter aortic valve implantation.
        J Heart Valve Dis. 2011; 20: 83-90
        • Binder R.K.
        • Webb J.G.
        • Toggweiler S.
        • Freeman M.
        • Barbanti M.
        • Willson A.B.
        • Alhassan D.
        • Hague C.J.
        • Wood D.A.
        • Leipsic J.
        Impact of post-implant SAPIEN XT geometry and position on conduction disturbances, hemodynamic performance, and paravalvular regurgitation.
        JACC Cardiovasc Interv. 2013; 6: 462-468