Background
Recent data from randomised and observational studies have reported non-inferior outcomes
for transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve
replacement (SAVR) in intermediate-risk patients. We performed a systematic review
to evaluate the mortality of TAVI compared to SAVR in intermediate-risk patients.
Methods
A comprehensive search of four major databases (Embase, Ovid MEDLINE, PubMed, and
Google Scholar) was performed from their inception to 29 April 2016. We included original
research studies reporting data on TAVI and SAVR in intermediate-risk patients. We
compared the outcomes of TAVI to SAVR.
Results
A total of 2,375 and 2,377 intermediate-risk patients underwent TAVI and SAVR respectively.
The 30-day all-cause (p = 0.07), 30-day cardiac (p = 0.53), and 12-month all-cause mortality (p = 0.34) was similar between the two groups. However, TAVI through transfemoral access
had a significantly lower mortality than SAVR (OR 0.58, p = 0.006). The incidence of ≥moderate aortic incompetence (p < 0.00001) and pacemaker implantation (p < 0.0001) was higher in the TAVI group.
Conclusions
In the intermediate-risk patients, the 30-day and 12-month mortality are similar between
TAVI and SAVR. Increased operator experience and improved device technology have led
to a significant reduction in mortality in intermediate-risk patients undergoing TAVI.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.The New England Journal of Medicine. 2010; 363: 1597-1607
- Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.Journal of the American College of Cardiology. 2014; 63: 1972-1981
- Procedural results and clinical outcomes of transcatheter aortic valve implantation in Switzerland: An observational cohort study of Sapien 3 versus Sapien XT transcatheter heart valves.Circulation Cardiovascular Interventions. 2015; 8
- Medtronic corevalve evolut valve.EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2012; 8: Q94-Q96
- 1-year outcomes with the fully repositionable and retrievable lotus transcatheter aortic replacement valve in 120 high-risk surgical patients with severe aortic stenosis: Results of the REPRISE II study.JACC Cardiovascular Interventions. 2016; 9: 376-384
- Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers notion randomized clinical trial.Journal of the American College of Cardiology. 2015; 65: 2184-2194
- Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: A propensity score-matched case-control study.American Heart Journal. 2012; 164: 910-917
- A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients.JACC Cardiovascular Interventions. 2013; 6: 443-451
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.Int J Surg. 2010; 8: 336-341
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: The valve academic research Consortium-2 consensus document.The Journal of Thoracic and Cardiovascular Surgery. 2013; 145: 6-23
- Quality of reporting of observational longitudinal research.American Journal of Epidemiology. 2005; 161: 280-288
- A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: The STACCATO trial.EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2012; 8: 383-389
- Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: Results from an intermediate risk propensity-matched population of the Italian observant study.International Journal of Cardiology. 2013; 167: 1945-1952
- A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk.Catheterization and Cardiovascular Interventions: official journal of the Society for Cardiac Angiography & Interventions. 2015; 86: 738-744
- Influence of different approaches of aortic valve replacement on the incidence of post-operative delirium in intermediate risk patients – a matched pair analysis.Current Medical Research and Opinion. 2015; 31: 2157-2163
- Transcatheter or surgical aortic-valve replacement in intermediate-risk patients.New England Journal of Medicine. 2016; 374: 1609-1620
- Prediction of operative mortality after valve replacement surgery.Journal of the American College of Cardiology. 2001; 37: 885-892
- Death and other time-related events after valve replacement.Circulation. 1985; 72: 753-767
- Comprehensive analysis of mortality among patients undergoing TAVR: Results of the PARTNER trial.Journal of the American College of Cardiology. 2014; 64: 158-168
- Permanent pacemaker insertion after corevalve transcatheter aortic valve implantation: Incidence and contributing factors (the UK CoreValve Collaborative).Circulation. 2011; 123: 951-960
- Transcatheter aortic valve replacement with the Sapien 3a new balloon-expandable transcatheter heart valve.JACC Cardiovascular Interventions. 2013; 6: 293-300
- Transcatheter aortic valve replacement for severe symptomatic aortic stenosis using a repositionable valve system: 30-day primary endpoint results from the REPRISE II study.Journal of the American College of Cardiology. 2014; 64: 1339-1348
- The German aortic valve registry: 1-year results from 13,680 patients with aortic valve disease.European Journal of Cardio-Thoracic Surgery: official journal of the European Association for Cardio-thoracic Surgery. 2014; 46: 808-816
Article info
Publication history
Published online: April 11, 2017
Accepted:
February 28,
2017
Received in revised form:
November 15,
2016
Received:
May 26,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
