Why the study?
Numerous systematic literature reviews have evaluated TAVI across different risk groups, but no overview of reviews had summarized extant findings on TAVI performance over time.
Does TAVI improve clinical outcomes and reduce complications compared to SAVR in patients with severe aortic stenosis?
Does TAVI improve clinical outcomes and reduce complications compared to SAVR in patients with severe aortic stenosis?
This overview of systematic reviews confirms that TAVI offers comparable mortality to SAVR with lower risks of bleeding and acute kidney injury, but higher risks of pacemaker implantation and vascular complications across various surgical risk profiles.
First OoSR on TAVI outcomes; leaves open standardized quality appraisal before guiding low-risk patient selection.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a well-established treatment for high and intermediate-risk patients with severe aortic stenosis (AS). Recent studies have demonstrated non-inferiority of TAVI compared to surgery in low-risk patients. In the past decade, numerous literature reviews (SLRs) have assessed the use of TAVI in different risk groups. This is the first attempt to provide an overview of SRs (OoSRs) focusing on secondary studies reporting clinical outcomes/process indicators. This research aims to summarize the findings of extant literature on the performance of TAVI over time. METHODS: A literature search took place from inception to April 2024. We searched MEDLINE and the Cochrane Library for SLRs. SLRs reporting at least one review of clinical indicators were included. Subsequently, a two-step inclusion process was conducted: [1] screening based on title and abstracts and [2] screening based on full-text papers. Relevant data were extracted and the quality of the reviews was assessed. RESULTS: We included 33 SLRs with different risks assessed via the Society of Thoracic Surgeons (STS) score. Mortality rates were comparable between TAVI and Surgical Aortic Valve Replacement (SAVR) groups. TAVI is associated with lower rates of major bleeding, acute kidney injury (AKI) incidence, and new-onset atrial fibrillation. Vascular complications, pacemaker implantation, and residual aortic regurgitation were more frequent in TAVI patients. CONCLUSION: This study summarizes TAVI performance findings over a decade, revealing a shift to include both high and low-risk patients since 2020. Overall, TAVI continues to evolve, emphasizing improved outcomes, broader indications, and addressing challenges.
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Angioletti et al. (2024) studied this question.
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