PulseExploreJournal ClubResearchersJournals
Instagram
HomeJournal ClubExplore
Synapse
⌘+K
Synapse
January 1, 2020Cardiology ResearchOpen Access

Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review

View Full Paper
Ask AI
Bookmark
Share

Why the study?

TAVR was recently approved by the FDA for lower risk patients with severe aortic stenosis, warranting a meta-analysis comparing 30-day and 1-year outcomes between TAVR and SAVR in this population.

Does transcatheter aortic valve replacement reduce 30-day and 1-year all-cause mortality compared to surgical aortic valve replacement in lower risk patients?

Population

4,859 lower risk patients with Society of Thoracic Surgeons score < 4% or equivalent

Comparison

TAVR vs SAVR

Follow-up

1 year

Key result

Transcatheter aortic valve replacement significantly reduced the risk of 30-day all-cause mortality by 40.1% compared to surgical aortic valve replacement in lower risk patients.

Authors

MKMuhammad Shayan KhanTMTanveer MirWUWaqas Ullah

Discussion

Loading...

Member takes

Overview

Supports TAVR preference in lower-risk aortic stenosis; extends randomized evidence beyond high- and intermediate-risk populations.

Study Design

Type

Meta-Analysis (n=4,859)

Multicenter

Yes

Structured PICO

Does transcatheter aortic valve replacement reduce 30-day and 1-year all-cause mortality compared to surgical aortic valve replacement in lower risk patients?

P
Population
4,859 lower risk patients (Society of Thoracic Surgeons score < 4% or equivalent mean Euro SCORE) with severe aortic stenosis across 7 clinical trials. Mean age ranged from 73 to 83.7 years.
I
Intervention
Transcatheter aortic valve replacement (TAVR)
C
Comparator
Surgical aortic valve replacement (SAVR)
O
Outcome
30-day and 1-year all-cause mortalityhard clinical

Main Result

Effect estimate: RR 0.59 (95% CI 0.38 - 0.92)

p-value: p=0.02

In lower risk patients with severe aortic stenosis, TAVR significantly reduces 30-day all-cause mortality compared to SAVR, though it is associated with higher rates of permanent pacemaker implantation and vascular complications.

Limitations

  • Included only randomized control trials which might miss some confounding factors usually noted by observational studies
  • Comparison of different valves which may influence outcome of TAVR such as PPM or valvular insufficiency
  • Failed to stratify patients into different subgroups according to different access of intervention
  • Significant heterogeneity was observed in some effect outcomes
  • Included only randomized control trials which might miss confounding factors usually noted by observational studies

Cite This Study

Khan et al. (2020) conducted a meta-analysis in severe aortic stenosis (n=4,859). Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on 30-day all-cause mortality (RR 0.59, 95% CI 0.38 - 0.92, p=0.02). Transcatheter aortic valve replacement significantly reduced the risk of 30-day all-cause mortality by 40.1% compared to surgical aortic valve replacement in lower risk patients.

synapsesocial.com/papers/6a1d7bc5cc9f7df1b70582a1https://doi.org/10.14740/cr1046
View Full Paper
Ask AI
Bookmark
Share

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial2018 · 73 citations
  2. 2Durability of Transcatheter and Surgical Bioprosthetic Aortic Valves in Patients at Lower Surgical Risk2019 · 323 citations
  3. 3Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients2017 · 3,026 citations
  4. 4Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis2016 · 140 citations
  5. 5Transcatheter Aortic-Valve Replacement with a Self-Expanding Prosthesis2014 · 2,915 citations