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November 6, 2023Journal of the American Heart AssociationOpen Access

Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data

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Why the study?

Does TAVR improve survival compared to SAVR in low-risk patients?

Population

Low-risk patients

Comparison

TAVR vs SAVR

Design

Meta-analysis of reconstructed time-to-event data

Key result

SAVR appeared to be associated with improved survival beyond 2 years compared to TAVR in low-risk patients, but this benefit was observed only in propensity score-matched studies and not in RCTs.

Authors

MSMichel Pompeu SáXJXander JacquemynJEJef Van den Eynde

Discussion

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Overview

SAVR survival benefit in low-risk patients should not yet change practice; leaves open need for extended RCT follow-up to resolve observational-RCT discordance.

Study Design

Type

Meta-Analysis

Structured PICO

Does TAVR improve survival compared to SAVR in low-risk patients?

P
Population
Low-risk patients requiring aortic valve replacement
I
Intervention
Transcatheter Aortic Valve Replacement (TAVR)
C
Comparator
Surgical Aortic Valve Replacement (SAVR)
O
Outcome
Survival beyond 2 yearshard clinical

Main Result

p-value: p=0.398

In low-risk patients, SAVR may be associated with improved midterm survival compared to TAVR, though this finding is currently driven by observational data rather than randomized trials.

Limitations

  • Requires data from ongoing RCTs and longer follow-up in previous RCTs to confirm mid- and long-term survival differences
  • Survival benefit of SAVR was observed only in PSM studies and not in RCTs
  • Need for longer follow-up in previous RCTs to confirm findings

Cite This Study

Sá et al. (2023) conducted a meta-analysis in Aortic valve disease in low-risk patients. Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on Survival (p=0.398). SAVR appeared to be associated with improved survival beyond 2 years compared to TAVR in low-risk patients, but this benefit was observed only in propensity score-matched studies and not in RCTs.

synapsesocial.com/papers/6a053f5d4b24269796380731https://doi.org/10.1161/jaha.123.030012
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