Key result
TAVR yields similar short-term mortality compared to SAVR in nonagenarians.
Why the study?
Nonagenarians are increasingly being considered for TAVR since its approval, but comparative outcomes versus SAVR in this population required evaluation.
Does transcatheter aortic valve replacement reduce short-term mortality in nonagenarians with severe aortic stenosis compared to surgical aortic valve replacement?
Meta-Analysis (n=8,389)
Does transcatheter aortic valve replacement reduce short-term mortality in nonagenarians with severe aortic stenosis compared to surgical aortic valve replacement?
In nonagenarians with severe aortic stenosis, TAVR offers similar short-term mortality to SAVR but with shorter hospital stays and lower risks of AKI and transfusion, despite a higher risk of vascular complications.
Answers are grounded in this paper and cite their sources.
Supports TAVR as alternative to SAVR in nonagenarians; extends comparative evidence to extreme elderly.
Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis.Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay.Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76–1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62–0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62–0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70–1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65–4.333), p < 0.001].Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home.
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Latif et al. (2021) conducted a meta-analysis in severe aortic stenosis (n=8,389). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on short-term mortality (RR 0.91, 95% CI 0.76-1.10, p=0.318). Transcatheter aortic valve replacement in nonagenarians resulted in similar short-term mortality compared to surgical replacement (RR 0.91; 95% CI 0.76-1.10; p=0.318).
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