Key result
MiAVR shows no difference in 30-day mortality compared to TAVI in matched patients.
Why the study?
Minimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) avoid complete sternotomy, but a direct comparison of early outcomes between these two methods was needed.
Does minimally invasive aortic valve replacement improve early clinical outcomes compared to transcatheter aortic valve implantation in patients with aortic stenosis?
Meta-Analysis (n=9,744)
Does minimally invasive aortic valve replacement improve early clinical outcomes compared to transcatheter aortic valve implantation in patients with aortic stenosis?
Relative Risk: 0.99 (95% CI 0.58–1.7)
Absolute Event Rate: 2.5% vs 2.7%
p-value: p=0.97
In propensity-matched patients with aortic stenosis, MiAVR and TAVI provide equivalent short-term mortality, with MiAVR associated with lower rates of pacemaker requirement and paravalvular leak but higher rates of acute kidney injury.
Supports equivalent short-term mortality for MiAVR and TAVI in matched patients; leaves open whether RCTs will confirm differences in pacemaker implantation and AKI.
Background: Minimally invasive aortic valve replacement (MiAVR) and transcatheter aortic valve implantation (TAVI) provide aortic valve replacement (AVR) by less invasive methods than conventional surgical AVR, by avoiding complete sternotomy. This study directly compares and analyses the available evidence for early outcomes between these two AVR methods.Methods: Electronic databases were searched from inception until August 2019 for studies comparing MiAVR to TAVI, according to predefined search criteria. Propensity-matched studies with sufficient data were included in a meta-analysis.Results: Eight studies with 9,744 patients were included in the quantitative analysis. Analysis of risk-matched patients showed no difference in early mortality (RR 0.76, 95% CI, 0.37–1.54, P=0.44). MiAVR had a signal towards lower rate of postoperative stroke, although this did not reach statistical significance (OR 0.42, 95% CI, 0.13–1.29, P=0.13). MiAVR had significantly lower rates of new pacemaker (PPM) requirement (OR 0.29, 95% CI, 0.16–0.52, P<0.0001) and postoperative aortic insufficiency (AI) or paravalvular leak (PVL) (OR 0.05, 95% CI, 0.01–0.20, P<0.0001) compared to TAVI, (OR 0.42, 95% CI, 0.13–1.29, P=0.13), while acute kidney injury (AKI) was higher in MiAVR compared to TAVI (11.1% vs. 5.2%, OR 2.28, 95% CI, 1.25–4.16, P=0.007).Conclusions: In patients of equivalent surgical risk scores, MiAVR may be performed with lower rates of postoperative PPM requirement and AI/PVL, higher rates of AKI and no statistical difference in postoperative stroke or short-term mortality, compared to TAVI. Further prospective trials are needed to validate these results.
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Doyle et al. (2021) conducted a meta-analysis in Aortic stenosis (n=9,744). Minimally invasive aortic valve replacement (MiAVR) vs. Transcatheter aortic valve implantation (TAVI) was evaluated on Early mortality (within 30 days following the procedure) (RR 0.99, 95% CI 0.58-1.70, p=0.97). Minimally invasive aortic valve replacement showed no significant difference in 30-day mortality compared to transcatheter aortic valve implantation in propensity-matched patients (RR 0.99).
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