Key result
Transcatheter aortic valve replacement had a comparable risk of all cerebrovascular events (RR 0.94; 95% CI 0.75-1.17) compared to surgical aortic valve replacement at 30 days.
Why the study?
Does TAVR compared to SAVR reduce the risk of cerebrovascular events in patients requiring aortic valve replacement?
Meta-Analysis (n=5,414)
Does TAVR compared to SAVR reduce the risk of cerebrovascular events in patients requiring aortic valve replacement?
Relative Risk: 0.94 (95% CI 0.75–1.17)
TAVR and SAVR have comparable risks of major stroke, all stroke, and all cerebrovascular events at 30 days and 1 year of follow-up.
No significant major stroke difference; confirms comparable cerebrovascular safety and extends pooled trial evidence.
AIMS: Transcatheter aortic valve replacement (TAVR) has become the procedure of choice for inoperable patients and a safe alternative to surgical aortic valve replacement (SAVR) among moderate-risk patients. We used meta-analysis to compare the incidence of cerebrovascular events amongst patients undergoing TAVR and SAVR in randomised controlled trials (RCT). METHODS AND RESULTS: Our search revealed five RCT published between 2011 and 2017 with a total of 5,414 patients. Data were summarised as Mantel-Haenszel relative risk (RR) and 95% confidence intervals (CI). The risk of major stroke (RR 0.89, 95% CI: 0.53-1.51), all strokes (RR 0.85, 95% CI: 0.59-1.22) and all cerebrovascular events (RR 0.94, 95% CI: 0.75-1.17) was comparable between patients undergoing TAVR and SAVR at 30 days of follow-up. The risk of all strokes (RR 0.92, 95% CI: 0.69-1.22), major stroke (RR 0.92, 95% CI: 0.62-1.37) and all cerebrovascular events (RR 1.03, 95% CI: 0.79-1.33) was comparable between TAVR and SAVR at one year of follow-up. The incidence of major stroke (RR 1.02, 95% CI: 0.64-1.61), all strokes (RR 1.12, 95% CI: 0.78-1.62) and all cerebrovascular events (RR 1.23, 95% CI: 0.91-1.66) was comparable between TAVR and SAVR between 30 days and one year of follow-up. CONCLUSIONS: In our meta-analysis of RCT comparing TAVR and SAVR, we showed comparable risk of major stroke, all stroke and all cerebrovascular events.
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Mohananey et al. (2018) conducted a meta-analysis in Aortic valve disease (n=5,414). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on All cerebrovascular events at 30 days (RR 0.94, 95% CI 0.75-1.17). Transcatheter aortic valve replacement had a comparable risk of all cerebrovascular events (RR 0.94; 95% CI 0.75-1.17) compared to surgical aortic valve replacement at 30 days.
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