Comparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Amos Levi¹  Ran Kornowski¹  Yeela Talmor-Barkan¹  Troels Højsgaard Jørgensen²  Lars Søndergaard²  Tsahi T. Lerman³ 

[1] Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel;The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel;Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel;The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

关键词: TAVI;    SAVR;    durability;    structural valve deterioration;    bioprosthetic valve failure;   

DOI  :  10.3389/fcvm.2023.1242608

 received in 2023-06-19, accepted in 2023-08-21,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThis study aims to compare valve durability between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).MethodsWe conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The primary outcome was structural valve deterioration (SVD). Secondary outcomes were bioprosthetic valve failure, reintervention, effective orifice area (EOA), mean pressure gradient, and moderate–severe aortic regurgitation (AR, transvalvular and/or paravalvular).ResultsTwenty-five publications from seven RCTs consisting of 7,970 patients were included in the analysis with follow-up ranges of 2–8 years. No significant difference was found between the two groups with regard to SVD [odds ratio (OR) 0.72; 95% CI: 0.25–2.12]. The TAVI group was reported to exhibit a statistically significant higher risk of reintervention (OR 2.03; 95% CI: 1.34–3.05) and a moderate–severe AR (OR 6.54; 95% CI: 3.92–10.91) compared with the SAVR group. A trend toward lower mean pressure gradient in the TAVI group [(mean difference (MD) −1.61; 95% CI: −3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08–0.31) was noted.ConclusionThe present data indicate that TAVI provides a comparable risk of SVD with favorable hemodynamic profile compared with SAVR. However, the higher risk of significant AR and reintervention was demonstrated.Systematic Review RegistrationPROSPERO (CRD42022363060).

【 授权许可】

Unknown   
© 2023 Lerman, Levi, Jørgensen, Søndergaard, Talmor-Barkan and Kornowski.