The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Meta-Analysis of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in patients at Low Surgical Risk

DOI: 10.4244/EIJ-D-19-00663

1. Department of Cardiology, Rabin medical centre, Petach-Tikvi, Isreal; Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Isreal, Israel
2. Department of Cardiology, Rabin medical center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel.
3. Department of Cardiology, Rabin medical center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel.
4. Infectious diseases unit, Rabin medical center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel.
5. Department of Cardiology, Rabin medical center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv university, Tel-Aviv, Israel.
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Aims: Although transcatheter aortic valve replacement (TAVI) is officially indicated for severe aortic stenosis (AS) patients at intermediate or higher surgical risk,  the procedure is increasingly being performed  in patients who are at low surgical risk as well, data on the benefit of TAVI in this patient population is limited. 

Methods and results: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) of TAVI vs. surgical aortic valve replacement (SAVR) in patients who are at low surgical risk (mean STS score <4% and/or logistic EuroScore <10%). The primary outcome was mortality (examined at 30 days,  year and longest available follow up). The secondary outcomes included procedural complications.Nine studies (n=6,124) were included. TAVI was associated with a numerically, but not statistically significant reduced mortality at 30 days (1.45 vs. 2.1%, p=0.05), and similar mortality at 1 year (5.1% vs. 5.0%, p=0.74),and a median of 2 years (10.8% vs. 9.8%, p=0.15). For both time points, there was significant heterogeneity between RCT/PSM studies, with the former suggesting survival advantage for TAVI  and the latter for SAVR. In terms of periprocedural complications, TAVI was associated with reduced risk for stroke, bleeding and renal failure and an increase in vascular complications and Pacemaker implantation. 

Conclusions: in patients who are at low surgical risk, TAVI seems to be  associated with equivalent mortality up to a median follow up of 2 years compared to SAVR. More data is required before TAVI can be routinely considered as an alternative for SAVR in low risk patients.

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