Long‐term survival after transcatheter versus surgical aortic valve replacement for aortic stenosis: A meta‐analysis of observational comparative studies with a propensity‐score analysis

Abstract Objectives To synthesize evidence regarding long‐term survival after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) from real‐world clinical practice, we performed a meta‐analysis of observational studies with a propensity‐score analysis and ≥3‐year follow‐up. Methods Databases including MEDLINE and EMBASE were searched through April 2017 using PubMed and OVID. Eligible studies were observational comparative studies with a propensity‐score analysis of TAVI versus SAVR enrolling patients with severe AS and reporting ≥3‐year all‐cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow‐up (including early) mortality for TAVI versus SAVR was extracted from each individual study. Results Our search identified 14 eligible studies enrolling a total of 4,197 patients. A pooled analysis of all the 14 studies demonstrated a statistically significant 54% increase in mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31–1.81; P for effect < 0.00001; P for heterogeneity = 0.14; I 2 = 30%). Several sensitivity analyses did not substantially change the statistically significant benefit for SAVR. There was no evidence of significant publication bias. Conclusions On the basis of a meta‐analysis of 14 observational comparative studies with a propensity‐score analysis including a total of ≥4,000 patients, TAVI is associated with worse ≥3‐year overall survival than SAVR.