Key result
Transcatheter aortic valve replacement significantly reduced the incidence of 30-day/in-hospital new-onset atrial fibrillation compared to surgical aortic valve replacement (10.4% vs 35.5%, RR 0.31).
Why the study?
New-onset atrial fibrillation is prevalent after both TAVR and SAVR, but comprehensive comparisons of its incidence at different follow-up times were needed.
Does TAVR reduce the incidence of new-onset atrial fibrillation compared to SAVR in patients with severe aortic disease?
Meta-Analysis (n=13,310)
Yes
Does TAVR reduce the incidence of new-onset atrial fibrillation compared to SAVR in patients with severe aortic disease?
TAVR significantly reduces the risk of postprocedural new-onset atrial fibrillation up to 5 years compared to SAVR, though it is associated with higher rates of permanent pacemaker implantation and vascular complications.
Answers are grounded in this paper and cite their sources.
TAVR reduces postprocedural atrial fibrillation versus SAVR; confirms advantage in Level 1 meta-analysis of aortic valve replacement.
BACKGROUND: Presently, transcatheter aortic valve replacement (TAVR) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, after surgical aortic valve replacement (SAVR) and TAVR, the incidence of new-onset atrial fibrillation (NOAF) is prevalently found. This meta-analysis was designed to comprehensively compare the incidence of NOAF at different times after TAVR and SAVR for patients with severe aortic disease. METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVR and SAVR in the treatment of severe aortic disease. The primary outcomes were the incidence of NOAF with early, midterm and long term follow-up. The secondary outcomes included permanent pacemaker (PM) implantation, myocardial infarction (MI), cardiogenic shock, as well as mortality and other complications. Two reviewers assessed trial quality and extracted the data independently. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2. RESULTS: A total of 16 studies including 13,310 patients were identified. The pooled results indicated that, compared with SAVR, TAVR experienced a significantly lower incidence of 30-day/in-hospital, 1-year, 2-year, and 5-year NOAF, with pooled risk ratios (RRs) of 0.31 (95% confidence interval [CI] 0.23-0.41; 5725 pts), 0.30 (95% CI 0.24-0.39; 6321 pts), 0.48 (95% CI 0.38-0.61; 3441 pts), and 0.45 (95% CI 0.37-0.55; 2268 pts) respectively. In addition, TAVR showed lower incidence of MI (RR 0.62; 95% CI 0.40-0.97) and cardiogenic shock (RR 0.34; 95% CI 0.19-0.59), but higher incidence of permanent PM (RR 3.16; 95% CI 1.61-6.21) and major vascular complications (RR 2.22; 95% CI 1.14-4.32) at 30-day/in-hospital. At 1- and 2-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of neurological events, transient ischemic attacks (TIA), permanent PM, and major vascular complications, respectively. At 5-year after procedure, compared with SAVR, TAVR experienced a significantly higher incidence of TIA and re-intervention respectively. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVR and SAVR. CONCLUSIONS: Our analysis showed that TAVR was superior to SAVR in decreasing the both short and long term postprocedural NOAF. TAVR was equal to SAVR in early, midterm and long term mortality. In addition, TAVR showed lower incidence of 30-day/in-hospital MI and cardiogenic shock after procedure. However, pooled results showed that TAVR was inferior to SAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications, and re-intervention.
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Ding et al. (2021) conducted a meta-analysis in Severe aortic disease (n=13,310). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day/in-hospital new-onset atrial fibrillation (NOAF) (RR 0.31, 95% CI 0.23-0.41, p=<0.00001). Transcatheter aortic valve replacement significantly reduced the incidence of 30-day/in-hospital new-onset atrial fibrillation compared to surgical aortic valve replacement (10.4% vs 35.5%, RR 0.31).
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