Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients at low to moderate surgical risk: a comprehensive meta-analysis

BMC Cardiovascular Disorders

Research Article

Osama Mahmoud Abdelaty¹  Ammar Ismail²  Ahmed Elmaraezy²  Ahmed Ramadan Abdallah³  Ahmed Magdy Aboelfotoh³  Hossam Mahmoud Hassan⁴  Ammar M. AlSafadi⁵  Aya Gamal Elmaraezy⁶  Mahmoud Morsi⁶  Moath Althaher⁷  Farah Althaher⁷  Soha Saad⁸  Ahmed Negida⁹  Moutaz Eltoomy^1,10  Abdelrahman Ibrahim Abushouk^1,11 

[1] Ahmed Maher Teaching Hospital, Cairo, Egypt;Faculty of Medicine, Al-Azhar University, Cairo, Egypt;NovaMed Medical Research Association, Cairo, Egypt;Faculty of Medicine, Benha University, Benha, Egypt;Faculty of Medicine, Beni Suef University, Beni suef, Egypt;Faculty of Medicine, Damascus University, Damascus, Syria;Faculty of Medicine, Minoufia University, Shebin El-Kom, Egypt;Faculty of Medicine, Misr University for science and technology (MUST), 6th of October City, Giza, Egypt;Faculty of Medicine, Tanta University, Tanta, Egypt;Faculty of Medicine, Zagazig University, Zagazig, Egypt;Genetic Engineering & Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat City, Egypt;NovaMed Medical Research Association, Cairo, Egypt;Faculty of Medicine, Ain Shams University, Cairo, Egypt;

关键词: Aortic stenosis;    Aortic valve replacement;    Meta-analysis;    Surgical;    Transcatheter;   

DOI  :  10.1186/s12872-017-0668-1

 received in 2017-07-29, accepted in 2017-08-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRecently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS.MethodsA systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows.ResultsAt one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [−0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR.ConclusionsDue to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.

【 授权许可】

CC BY   
© The Author(s). 2017