TAVR was associated with lower risks of atrial fibrillation, AKI, and bleeding compared to SAVR, but higher risks of permanent pacemaker implantation (RR 2.50; 95% CI 2.26-2.75).
Meta-Analysis (n=11,069,277)
Yes
Does TAVR improve clinical outcomes compared to SAVR in real-world patients undergoing aortic valve replacement?
In a massive real-world meta-analysis, TAVR showed similar mortality and stroke rates to SAVR but a different complication profile, with less AF, AKI, and bleeding, but more pacemakers and vascular complications.
Effect estimate: RR 2.50 (95% CI 2.26-2.75)
Abstract Background Transcatheter aortic valve replacement (TAVR) has emerged as an minimally invasive alternative to surgical aortic valve replacement (SAVR). Purpose This study aimed to compare the use of TAVR and SAVR in real-world patient populations. Methods We searched PubMed and Embase from inception to 31st July 2024 to identify relevant studies. Population-based studies and registries were included in this study. Prevalences were expressed as proportions with 95% confidence interval (CI) and dichotomous data were expressed using risk ratio (RR) with 95% CI. The DerSimonian and Laird random-effects model was used to compute the pooled estimates. Statistical analysis was conducted in Rstudio. Results We identified 311 studies (n = 11 069 277) from 26 countries. Among patients undergoing aortic valve replacement (AVR), 39.1% (95% CI, 36.3 – 41.9%) underwent TAVR and 60.9% (95% CI, 58.1 – 63.7%) went SAVR. The prevalence of TAVR was 48.1% (95% CI, 39.8 – 56.5%) in Asia, 43.6% (95% CI, 9.7 – 84.8%) in Oceania, 42.3% (95% CI, 38.3 – 46.4%) in Europe, and 33.8% (95% CI, 29.8 – 38.1%) in North America. Overall, the proportion of TAVR remained consistent in studies conducted from 2015 (42.0%, 95% CI, 38.3 – 46.4%) to 2024 (45.1%, 95% CI, 37.9 – 52.5%). However, there was an increasing trend in North America, with TAVR rising from 21.5% (95% CI, 1.9 – 79.8%) in 2015 to 49.1% (95% CI, 37.6 – 60.9%) in 2024. Clinically, TAVR was associated with lower risks of atrial fibrillation (RR: 0.35, 95% CI 0.28 – 0.43), acute kidney injury or dialysis (RR: 0.69, 95% CI 0.62 – 0.76), bleeding or blood transfusion (RR: 0.46, 95% CI 0.41 – 0.52) but higher risks of permanent pacemaker implantation (RR: 2.50, 95% CI 2.26 – 2.75) and vascular complications (RR: 3.00, 95% CI 2.23 – 4.03) compared to SAVR. However, no significant differences were observed in the risks of mortality, myocardial infarction, stroke, and aortic reintervention. Conclusion This study highlights the widespread adoption of TAVR as a treatment option for patients undergoing AVR. However, the higher risks of permanent pacemaker implantation and vascular complications associated with TAVR emphasize the need for careful patient selection.
Ong et al. (Sat,) conducted a meta-analysis in Aortic valve replacement (n=11,069,277). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Permanent pacemaker implantation (RR 2.50, 95% CI 2.26-2.75). TAVR was associated with lower risks of atrial fibrillation, AKI, and bleeding compared to SAVR, but higher risks of permanent pacemaker implantation (RR 2.50; 95% CI 2.26-2.75).