Key result
TAVI cuts in-hospital stroke ~50% vs SAVR with comparable mortality in pure AR.
Why the study?
Published studies comparing TAVI and SAVR in pure aortic regurgitation have yielded conflicting results.
Does transcatheter aortic valve implantation reduce in-hospital mortality and stroke compared to surgical aortic valve replacement in patients with pure aortic regurgitation?
Meta-Analysis (n=33,484)
Yes
Does transcatheter aortic valve implantation reduce in-hospital mortality and stroke compared to surgical aortic valve replacement in patients with pure aortic regurgitation?
Relative Risk: 0.89 (95% CI 0.56–1.42)
p-value: p=0.63
In patients with pure aortic regurgitation, TAVI is associated with similar in-hospital mortality but lower rates of in-hospital stroke, acute kidney injury, and major bleeding compared to SAVR, though with a higher risk of pacemaker implantation.
TAVI may reduce stroke in pure AR without mortality penalty; leaves open need for randomized confirmation before practice change.
Introduction The published studies comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in pure aortic regurgitation (AR) are conflicting. We conducted this systematic review and meta-analysis to compare TAVI with SAVR in pure AR. Methods We searched PubMed, Embase, Web of Science (WOS), Scopus, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) from inception until 23 June 2023. Review Manager was used for statistical analysis. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes. Continuous outcomes were compared using the mean difference (MD) and 95% CI. The inconsistency test (I 2 ) assessed the heterogeneity. We used the Newcastle-Ottawa scale to assess the quality of included studies. We evaluated the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale. Results We included six studies with 5633 patients in the TAVI group and 27,851 in SAVR. In-hospital mortality was comparable between TAVI and SAVR (RR = 0.89, 95% CI [0.56, 1.42], P = 0.63) (I 2 = 86%, P < 0.001). TAVI was favored over SAVR regarding in-hospital stroke (RR = 0.50; 95% CI [0.39, 0.66], P < 0.001) (I 2 = 11%, P = 0.34), in-hospital acute kidney injury (RR = 0.56; 95% CI: [0.41, 0.76], P < 0.001) ( I 2 = 91%, P < 0.001), major bleeding (RR = 0.23; 95% CI: [0.17, 0.32], P < 0.001) ( I 2 = 78%, P < 0.001), and shorter hospital say (MD = − 4.76 days; 95% CI: [− 5.27, − 4.25], P < 0.001) ( I 2 = 88%, P < 0.001). In contrast, TAVI was associated with a higher rate of pacemaker implantation (RR = 1.68; 95% CI: [1.50, 1.88], P < 0.001) ( I 2 = 0% P = 0.83). Conclusion TAVI reduces in-hospital stroke and is associated with better safety outcomes than SAVR in patients with pure AR.
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Elkasaby et al. (2024) conducted a meta-analysis in Pure aortic regurgitation (n=33,484). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on In-hospital mortality (RR 0.89, 95% CI 0.56, 1.42, p=0.63). Transcatheter aortic valve implantation resulted in comparable in-hospital mortality to surgical aortic valve replacement (RR 0.89) but significantly reduced the risk of in-hospital stroke by 50% in patients with pure aortic regurgitation.
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