1. Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement
- Author
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Sameer Arora, Paula D. Strassle, Matthew A. Cavender, Thomas G. Caranasos, John P. Vavalle, Satyanarayana R. Vaidya, Jacob A. Misenheimer, Evan N. Wheeler, Cassandra J. Ramm, and Jeremy A. Rhodes
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Myocardial Infarction ,030204 cardiovascular system & hematology ,Risk Assessment ,law.invention ,Cohort Studies ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Aortic valve replacement ,law ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Catheterization, Peripheral ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Randomized Controlled Trials as Topic ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Acute kidney injury ,Hemodynamics ,Atrial fibrillation ,General Medicine ,Aortic Valve Stenosis ,medicine.disease ,Femoral Artery ,Stroke ,Treatment Outcome ,Meta-analysis ,Aortic Valve ,Cohort ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. Methods We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion. Outcomes of interest included 30-day and 1-year mortality, and 30-day complications. If significant heterogeneity was found in the random effects meta-analyses, a sensitivity analysis which individually removed each study was conducted. Results Seven studies reported results on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). Conclusions TF-TAVR is associated with lower 30-day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF-TAVR outcomes.
- Published
- 2017