Near and medium term outcomes of transcatheter aortic valve replacement in elderly patients with aortic stenosis: A meta-analysis

It proves that transcatheter aortic valve replacement (TAVR) is effective in aortic valve stenosis (AS), but its efficacy and safety in elder patients are controversial. We compared the near and medium-term (2 years after surgery) all-cause mortality and complications in older AS patients who underwent TAVR versus surgical aortic valve replacement (SAVR). We searched the literature on TAVR in elderly patients with AS from PubMed, Embase, and Web of Science by computer. The search period is up to August 2023. We performed a meta-analysis in the RevMan 5.3 software. We selected 16 cohort studies with 18,183 patients (9,809 received TAVR and 8,374 received SAVR). Through meta analysis, we found that in comparison with the SAVR, 1-year postoperative stroke rate of the TAVR was lower [OR=0.65, 95%CI(0.54, 0.79), P<0.001], the 2-year re-hospitalization on rate in the TAVR group was higher[OR=1.27, 95%CI(1.11, 1.46), P=0.0005], and the 2-year bleeding rate was lower [I²=18%, FEM; OR=0.55, 95%CI(0.40, 0.77), P=0.0004]. The permanent pacemaker implantation (PPI) rate at 2 years after surgery of the TAVR was higher [OR=3.03, 95%CI (1.70, 5.39), P=0.0002] and the rate of New-onset Atrial Fibrillation (NOAF) 2 years after surgery was lower [OR=0.57, 95%CI(0.40, 0.83), P=0.004]. Therefore, we conclude that the near - and medium-term efficacy of TAVR in elderly patients with AS is generally better than that of SAVR, but with a higher risk of re-hospitalization and PPI 2 years after surgery.