Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis
| Autor: | Amol A. Bahekar, Sameer Arora, John P. Vavalle, Michael Yeung, Thomas G. Caranasos, Cassandra J. Ramm, Melissa C. Caughey, Jacob A. Misenheimer, Wesley M. Jones |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease Lower risk Surgery Clinical trial 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Aortic valve replacement Valve replacement Internal medicine Propensity score matching medicine Risk of mortality Cardiology Original Article Myocardial infarction Cardiology and Cardiovascular Medicine Prospective cohort study business |
| Zdroj: | Cardiovascular Diagnosis and Therapy. 6:241-249 |
| ISSN: | 2223-3660 2223-3652 |
| DOI: | 10.21037/cdt.2016.03.04 |
| Popis: | Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons. Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). Results: Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)]. Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR. |
| Databáze: | OpenAIRE |
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