Key result
In patients with severe aortic stenosis and prior cardiac surgery, TAVR showed no significant difference in 30-day all-cause mortality compared to SAVR (OR 0.87), but was associated with lower incidences of stroke and bleeding.
Why the study?
The number of patients with severe aortic stenosis and prior cardiac surgery has increased, and prior surgery increases risk of adverse outcomes after aortic valve replacement, necessitating evaluation of TAVR versus SAVR outcomes in this population.
Meta-Analysis (n=8,221)
Odds Ratio: 0.87 (95% CI 0.56–1.37)
Absolute Event Rate: 3% vs 3.26%
p-value: p=0.54
TAVR may be preferred to SAVR in severe AS with prior surgery for similar mortality and lower stroke/bleeding; extends evidence to reoperative patients.
The number of patients with severe aortic stenosis (AS) and a history of prior cardiac surgery has increased. Prior cardiac surgery increases the risk of adverse outcomes in patients undergoing aortic valve replacement. To evaluate the impact of prior cardiac surgery on clinical endpoints in patients undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), we performed a literature search using PubMed, Embase, Google Scholar, and Scopus databases. The clinical endpoints included in our study were 30-day mortality, 1–2-year mortality, acute kidney injury (AKI), bleeding, stroke, procedural time, and duration of hospital stay. Seven studies, which included a total of 8221 patients, were selected. Our study found that TAVR was associated with a lower incidence of stroke and bleeding complications. There was no significant difference in terms of AKI, 30-day all-cause mortality, and 1–2-year all-cause mortality between the two groups. The average procedure time and duration of hospital stay were 170 min less (p ≤ 0.01) and 3.6 days shorter (p < 0.01) in patients with TAVR, respectively. In patients with prior coronary artery bypass graft and severe AS, both TAVR and SAVR are reasonable options. However, TAVR may be associated with a lower incidence of complications like stroke and perioperative bleeding, in addition to a shorter length of stay.
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Latif et al. (2020) conducted a meta-analysis in Severe aortic stenosis with prior cardiac surgery (n=8,221). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day all-cause mortality (OR 0.87, 95% CI 0.56-1.37, p=0.54). In patients with severe aortic stenosis and prior cardiac surgery, TAVR showed no significant difference in 30-day all-cause mortality compared to SAVR (OR 0.87), but was associated with lower incidences of stroke and bleeding.
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