| Abstrakt: |
Introduction:Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment for severe aortic stenosis (AS) in patients who are at intermediate and high surgical risk. TAVR has not been well-studied in low risk patients until recently. This updated meta-analysis assesses the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) for low risk patients with severe AS.Methods:PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library were searched for randomized controlled trials (RCT) and cohort studies comparing TAVR to SAVR in low risk patients with severe AS. Studies were stratified based on study design. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for all endpoints with P < 0.05 set for significance.Results:Six studies (3 RCTs and 3 cohort studies) were included for this analysis pooling 24,156 patients total. At 1 year, all-cause mortality did not differ between treatment arms (OR: 0.99, 95% CI: 0.70-1.41) while cardiovascular mortality and incidence of disabling stroke both favored TAVR over SAVR (OR: 0.56, 95% CI: 0.31-0.98; and OR: 0.33, 95% CI: 0.14-0.75, respectively). The combined endpoint of all-cause death or disabling stroke at 1 year also favored TAVR over SAVR (OR: 0.49, 95% CI: 0.30-0.81). Short-term, TAVR was associated with more perivalvular leak (OR: 7.28, 95% CI: 3.44-15.39), conduction abnormalities requiring permanent pacemaker implantation (OR: 2.50, 95% CI: 1.71-3.66), and vascular complications (OR: 2.81, 95% CI: 1.09-7.24), but with less perioperative acute kidney injury stage ? 2 (OR:0.42, 95% CI: 0.24-0.72) and major bleeding (OR: 0.23, 95% CI: 0.13-0.38).Conclusions:For 1 year outcomes in elderly, low risk patients with calcific, tricuspid aortic stenosis, TAVR is superior to SAVR for cardiovascular mortality and for the combined outcome of all-cause death or disabling stroke. Short-term outcomes post-TAVR are congruent with previous studies. |
