A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis

Pedro A. Villablanca*, Verghese Mathew, Vinod H. Thourani, Josep Rodés-Cabau, Sripal Bangalore, Mohammed Makkiya, Peter Vlismas, David F. Briceno, David P. Slovut, Cynthia C. Taub, Patrick M McCarthy, John G. Augoustides, Harish Ramakrishna

*Corresponding author for this work

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥ 1 year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS. Methods A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016. Results Fifty studies enrolling 44,247 patients met the inclusion criteria. The mean duration follow-up was 21.4 months. No difference was found in long-term all-cause mortality (risk ratios (RR), 1.06; 95% confidence interval (CI) 0.91–1.22). There was a significant difference favoring TAVR in the incidence of stroke (RR, 0.82; 95% CI 0.71–0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33–0.54), acute kidney injury (RR, 0.70; 95% CI 0.53–0.92), and major bleeding (RR, 0.57; 95% CI 0.40–0.81). TAVR had significant higher incidence of vascular complications (RR, 2.90; 95% CI 1.87–4.49), aortic regurgitation (RR, 7.00; 95% CI 5.27–9.30), and pacemaker implantation (PPM) (RR, 2.02; 95% CI 1.51–2.68). TAVR demonstrated significantly lower stroke risk compared to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06–2.10); no differences in PPM implantation were observed in intermediate-risk patients (RR, 1.68; 95% CI 0.94–3.00). In a meta-regression analysis, the effect of TAVR baseline clinical features did not affect the long-term all-cause mortality outcome. Conclusion TAVR and SAVR showed similar long-term survival in patients with severe AS; with important differences in treatment-associated morbidity.

Original languageEnglish (US)
Pages (from-to)234-243
Number of pages10
JournalInternational Journal of Cardiology
Volume225
DOIs
StatePublished - Dec 15 2016

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Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Meta-Analysis
Odds Ratio
Confidence Intervals
Stroke
Aortic Valve Insufficiency
Mortality
Incidence
Transcatheter Aortic Valve Replacement
Acute Kidney Injury
PubMed
Atrial Fibrillation
Blood Vessels
Regression Analysis
Hemorrhage
Morbidity
Safety
Survival

Keywords

  • Aortic stenosis
  • Meta-analysis
  • Surgical
  • Transcatheter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Villablanca, Pedro A. ; Mathew, Verghese ; Thourani, Vinod H. ; Rodés-Cabau, Josep ; Bangalore, Sripal ; Makkiya, Mohammed ; Vlismas, Peter ; Briceno, David F. ; Slovut, David P. ; Taub, Cynthia C. ; McCarthy, Patrick M ; Augoustides, John G. ; Ramakrishna, Harish. / A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. In: International Journal of Cardiology. 2016 ; Vol. 225. pp. 234-243.
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abstract = "Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥ 1 year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS. Methods A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016. Results Fifty studies enrolling 44,247 patients met the inclusion criteria. The mean duration follow-up was 21.4 months. No difference was found in long-term all-cause mortality (risk ratios (RR), 1.06; 95{\%} confidence interval (CI) 0.91–1.22). There was a significant difference favoring TAVR in the incidence of stroke (RR, 0.82; 95{\%} CI 0.71–0.94), atrial fibrillation (RR, 0.43; 95{\%} CI 0.33–0.54), acute kidney injury (RR, 0.70; 95{\%} CI 0.53–0.92), and major bleeding (RR, 0.57; 95{\%} CI 0.40–0.81). TAVR had significant higher incidence of vascular complications (RR, 2.90; 95{\%} CI 1.87–4.49), aortic regurgitation (RR, 7.00; 95{\%} CI 5.27–9.30), and pacemaker implantation (PPM) (RR, 2.02; 95{\%} CI 1.51–2.68). TAVR demonstrated significantly lower stroke risk compared to SAVR in high-risk patients (RR, 1.49; 95{\%} CI 1.06–2.10); no differences in PPM implantation were observed in intermediate-risk patients (RR, 1.68; 95{\%} CI 0.94–3.00). In a meta-regression analysis, the effect of TAVR baseline clinical features did not affect the long-term all-cause mortality outcome. Conclusion TAVR and SAVR showed similar long-term survival in patients with severe AS; with important differences in treatment-associated morbidity.",
keywords = "Aortic stenosis, Meta-analysis, Surgical, Transcatheter",
author = "Villablanca, {Pedro A.} and Verghese Mathew and Thourani, {Vinod H.} and Josep Rod{\'e}s-Cabau and Sripal Bangalore and Mohammed Makkiya and Peter Vlismas and Briceno, {David F.} and Slovut, {David P.} and Taub, {Cynthia C.} and McCarthy, {Patrick M} and Augoustides, {John G.} and Harish Ramakrishna",
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Villablanca, PA, Mathew, V, Thourani, VH, Rodés-Cabau, J, Bangalore, S, Makkiya, M, Vlismas, P, Briceno, DF, Slovut, DP, Taub, CC, McCarthy, PM, Augoustides, JG & Ramakrishna, H 2016, 'A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis', International Journal of Cardiology, vol. 225, pp. 234-243. https://doi.org/10.1016/j.ijcard.2016.10.003

A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis. / Villablanca, Pedro A.; Mathew, Verghese; Thourani, Vinod H.; Rodés-Cabau, Josep; Bangalore, Sripal; Makkiya, Mohammed; Vlismas, Peter; Briceno, David F.; Slovut, David P.; Taub, Cynthia C.; McCarthy, Patrick M; Augoustides, John G.; Ramakrishna, Harish.

In: International Journal of Cardiology, Vol. 225, 15.12.2016, p. 234-243.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A meta-analysis and meta-regression of long-term outcomes of transcatheter versus surgical aortic valve replacement for severe aortic stenosis

AU - Villablanca, Pedro A.

AU - Mathew, Verghese

AU - Thourani, Vinod H.

AU - Rodés-Cabau, Josep

AU - Bangalore, Sripal

AU - Makkiya, Mohammed

AU - Vlismas, Peter

AU - Briceno, David F.

AU - Slovut, David P.

AU - Taub, Cynthia C.

AU - McCarthy, Patrick M

AU - Augoustides, John G.

AU - Ramakrishna, Harish

PY - 2016/12/15

Y1 - 2016/12/15

N2 - Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥ 1 year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS. Methods A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016. Results Fifty studies enrolling 44,247 patients met the inclusion criteria. The mean duration follow-up was 21.4 months. No difference was found in long-term all-cause mortality (risk ratios (RR), 1.06; 95% confidence interval (CI) 0.91–1.22). There was a significant difference favoring TAVR in the incidence of stroke (RR, 0.82; 95% CI 0.71–0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33–0.54), acute kidney injury (RR, 0.70; 95% CI 0.53–0.92), and major bleeding (RR, 0.57; 95% CI 0.40–0.81). TAVR had significant higher incidence of vascular complications (RR, 2.90; 95% CI 1.87–4.49), aortic regurgitation (RR, 7.00; 95% CI 5.27–9.30), and pacemaker implantation (PPM) (RR, 2.02; 95% CI 1.51–2.68). TAVR demonstrated significantly lower stroke risk compared to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06–2.10); no differences in PPM implantation were observed in intermediate-risk patients (RR, 1.68; 95% CI 0.94–3.00). In a meta-regression analysis, the effect of TAVR baseline clinical features did not affect the long-term all-cause mortality outcome. Conclusion TAVR and SAVR showed similar long-term survival in patients with severe AS; with important differences in treatment-associated morbidity.

AB - Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic-valve replacement (SAVR) for patients with severe symptomatic aortic stenosis (AS) who are at high operative risk. We sought to determine the long-term (≥ 1 year follow-up) safety and efficacy TAVR compared with SAVR in patients with severe AS. Methods A comprehensive search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, conference proceedings, and relevant Web sites from inception through 10 April 2016. Results Fifty studies enrolling 44,247 patients met the inclusion criteria. The mean duration follow-up was 21.4 months. No difference was found in long-term all-cause mortality (risk ratios (RR), 1.06; 95% confidence interval (CI) 0.91–1.22). There was a significant difference favoring TAVR in the incidence of stroke (RR, 0.82; 95% CI 0.71–0.94), atrial fibrillation (RR, 0.43; 95% CI 0.33–0.54), acute kidney injury (RR, 0.70; 95% CI 0.53–0.92), and major bleeding (RR, 0.57; 95% CI 0.40–0.81). TAVR had significant higher incidence of vascular complications (RR, 2.90; 95% CI 1.87–4.49), aortic regurgitation (RR, 7.00; 95% CI 5.27–9.30), and pacemaker implantation (PPM) (RR, 2.02; 95% CI 1.51–2.68). TAVR demonstrated significantly lower stroke risk compared to SAVR in high-risk patients (RR, 1.49; 95% CI 1.06–2.10); no differences in PPM implantation were observed in intermediate-risk patients (RR, 1.68; 95% CI 0.94–3.00). In a meta-regression analysis, the effect of TAVR baseline clinical features did not affect the long-term all-cause mortality outcome. Conclusion TAVR and SAVR showed similar long-term survival in patients with severe AS; with important differences in treatment-associated morbidity.

KW - Aortic stenosis

KW - Meta-analysis

KW - Surgical

KW - Transcatheter

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