Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement

Autor: 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, Jeremy A. Rhodes
Rok vydání: 2017
Předmět:
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
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 91(4)
ISSN: 1522-726X
Popis: 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.
Databáze: OpenAIRE
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