Key result
TAVI linked to ~13% lower risk of death or disabling stroke vs. surgical replacement.
Why the study?
With the expanding use of TAVI for severe symptomatic aortic stenosis, the authors sought to compare its early and mid-term safety and efficacy against SAVR.
Does transcatheter aortic valve implantation (TAVI) reduce all-cause mortality or disabling stroke compared to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis?
Meta-Analysis (n=8,780)
Does transcatheter aortic valve implantation (TAVI) reduce all-cause mortality or disabling stroke compared to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis?
Answers are grounded in this paper and cite their sources.
In patients with severe symptomatic aortic stenosis, TAVI is associated with lower early to mid-term mortality or disabling stroke compared to SAVR, though at the cost of higher vascular complications and pacemaker implantations.
(1) Background: The use of transcatheter aortic valve implantation (TAVI) for the treatment of severe symptomatic aortic stenosis is expanding significantly. We aimed to perform a meta-analysis comparing the safety and efficacy of TAVI versus surgical aortic valve replacement (SAVR) during the early and mid-term follow-up period. (2) Methods: We conducted a meta-analysis of randomized controlled trials (RCTs) comparing 1- to 2-year outcomes between TAVI and SAVR. The study protocol was preregistered in PROSPERO and the results were reported according to PRISMA guidelines. (3) Results: The pooled analysis included data from eight RCTs totaling 8780 patients. TAVI was associated with a lower risk of all-cause mortality or disabling stroke (OR 0.87, 95%CI 0.77-0.99), significant bleeding (OR 0.38, 95%CI 0.25-0.59), acute kidney injury (AKI; OR 0.53, 95%CI 0.40-0.69) and atrial fibrillation (OR 0.28, 95%CI 0.19-0.43). SAVR was associated with a lower risk of major vascular complication (MVC; OR 1.99, 95%CI 1.29-3.07) as well as permanent pacemaker implantation (PPI; OR 2.28, 95%CI 1.45-3.57). (3) Conclusions: TAVI compared with SAVR during early and mid-term follow-up was associated with a lower risk of all-cause mortality or disabling stroke, significant bleeding, AKI and atrial fibrillation; however, it was associated with a higher risk of MVC and PPI.
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Lerman et al. (2023) conducted a meta-analysis in Severe symptomatic aortic stenosis (n=8,780). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on All-cause mortality or disabling stroke (OR 0.87, 95% CI 0.77-0.99). Transcatheter aortic valve implantation was associated with a lower risk of all-cause mortality or disabling stroke compared to surgical replacement.
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