Key result
In patients with severe aortic stenosis and a small aortic annulus, TAVR and SAVR showed no significant difference in 30-day mortality (RR 0.68) or long-term survival, though TAVR reduced patient-prosthesis mismatch but increased pacemaker implantation.
Why the study?
To guide clinical decision-making by synthesizing available evidence comparing the performance of TAVR and SAVR specifically in patients with severe AS and a small aortic annulus.
Does TAVR improve clinical and echocardiographic outcomes compared to SAVR in patients with severe aortic stenosis and a small aortic annulus?
Meta-Analysis (n=3,670)
Yes
Does TAVR improve clinical and echocardiographic outcomes compared to SAVR in patients with severe aortic stenosis and a small aortic annulus?
Relative Risk: 0.68 (95% CI 0.32–1.45)
p-value: p=0.31
In patients with severe aortic stenosis and a small annulus, TAVR reduces patient-prosthesis mismatch and new-onset atrial fibrillation but increases the risk of pacemaker implantation, vascular complications, and paravalvular leak compared to SAVR.
TAVR lowers PPM and AF risks but raises PPI and vascular complications versus SAVR in small-annulus AS; extends trade-off data for individualized selection.
Background: -analysis, we aim to synthesize available evidence to guide clinical decision-making by comparing the performance of TAVR and SAVR, specifically in patients with severe AS and a small aortic annulus. Methods: We searched PubMed, EMBASE, Cochrane, Web of Science, and Scopus from inception till May 2024. The risk ratio (RR) and mean difference (MD) with a 95 % confidence interval (CI) are provided as effect size estimates, with all analyses being conducted using RevMan 5.4. Results: Eleven studies with 3,670 patients were included. TAVR significantly increased the risk of 2-year new permanent pacemaker implantation (PPI) (RR = 2.42; 95 % CI: [1.70-3.44], P < 0.0001) and major vascular complications (RR = 3.73; 95 % CI: [1.98-6.99], P < 0.0001) than SAVR. However, TAVR significantly decreased the risk of patient-prosthesis mismatch (PPM) (RR = 0.56; 95 % CI: [0.48-0.65], P < 0.00001) and new-onset atrial fibrillation (AF) (RR = 0.31; 95 % CI: [0.23-0.41], P < 0.00001). Also, SAVR reduced the risk of paravalvular leak (PVL) (RR = 3.35; 95 % CI: [1.79-6.27], P = 0.0002). Conclusion: TAVR had a significantly reduced risk of PPM and new-onset AF but with increased PPI and vascular complications. Also, TAVR significantly improved EOA and iEOA. Furthermore, SAVR had less risk of PVL, and better LVEF improvement at predischarge. Therefore, TAVR and SAVR remain valid alternatives, and decisions should be based on anatomy of the annulus and aortic root,operative risk, and comorbidities.
No takes yet. Share an insight, caveat, or question.
Awad et al. (2024) conducted a meta-analysis in Severe aortic stenosis with a small aortic annulus (n=3,670). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day mortality (RR 0.68, 95% CI 0.32-1.45, p=0.31). In patients with severe aortic stenosis and a small aortic annulus, TAVR and SAVR showed no significant difference in 30-day mortality (RR 0.68) or long-term survival, though TAVR reduced patient-prosthesis mismatch but increased pacemaker implantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: