The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies
| Autor: | Michael J. Mack, J. James Edelman, Sari D. Holmes, Piotr Suwalski, Susheel Kodali, John D. Carroll, Anson Cheung, Christopher Meduri, Jessica Forcillo, Vinod H. Thourani, Francis D. Ferdinand, Jeffrey J. Popma, Gregory P. Fontana, Michael A. Borger, Gilbert H.L. Tang, Tsuyoshi Kaneko, Niv Ad, Samir R. Kapadia, Michael J. Reardon, Tom C. Nguyen, Bob Kiaii, Husam H. Balkhy, Joerg Kempfert, Martin B. Leon |
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| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Consensus Statement (logic) medicine.medical_treatment 030204 cardiovascular system & hematology Risk Assessment Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Aortic valve replacement Risk Factors medicine Humans 030212 general & internal medicine Heart Valve Prosthesis Implantation business.industry Expert consensus Aortic Valve Stenosis General Medicine medicine.disease Surgery Stenosis Treatment Outcome Cardiothoracic surgery Aortic Valve Meta-analysis Cardiology and Cardiovascular Medicine Intermediate risk business |
| Zdroj: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 16:3-16 |
| ISSN: | 1559-0879 1556-9845 |
| DOI: | 10.1177/1556984520978316 |
| Popis: | Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease. |
| Databáze: | OpenAIRE |
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