Key result
TAVR is linked to ~46% lower short-term mortality vs SAVR in prior mediastinal radiation.
Why the study?
Mediastinal radiation potentiates aortic stenosis and complicates its treatment, requiring comparison of short- and midterm outcomes between TAVR and SAVR.
Does TAVR improve short-term and 1-year outcomes compared to SAVR in patients with symptomatic severe aortic stenosis and prior mediastinal radiation?
Meta-Analysis (n=4,331)
Does TAVR improve short-term and 1-year outcomes compared to SAVR in patients with symptomatic severe aortic stenosis and prior mediastinal radiation?
Effect estimate: RR 0.54 (95% CI 0.34-0.88)
In patients with severe aortic stenosis and prior mediastinal radiation, TAVR is associated with significantly better short-term survival and lower periprocedural morbidity compared to SAVR, though 1-year mortality appears similar.
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May support TAVR over SAVR in prior mediastinal radiation AS; extends evidence to this high surgical risk subgroup.
Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34–0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15–0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59–0.95), bleeding (RR: 0.37, 95% CI: 0.33–0.42), and shorter length of hospital stay (MD: −4.30; 95% CI: −5.45 to −3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50–2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings.
Elbenawi et al. (2026) conducted a meta-analysis in Symptomatic severe aortic stenosis and prior mediastinal radiation (n=4,331). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Short-term mortality (RR 0.54, 95% CI 0.34-0.88). In patients with prior mediastinal radiation, TAVR was associated with lower short-term mortality compared to SAVR (RR 0.54; 95% CI 0.34-0.88), with comparable 1-year mortality.
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