Comparison of transcatheter aortic valve implantation with other approaches to treat aortic valve stenosis: a systematic review and meta-analysis

Gernot Wagner, Sabine Steiner, Gerald Gartlehner, Henrike Arfsten, Brigitte Wildner, Harald Mayr, Deddo Moertl

Research output: Journal article (peer-reviewed)Review article

9 Citations (Scopus)

Abstract

BACKGROUND: Transcatheter aortic valve replacement (TAVI) is an alternative treatment for patients with symptomatic severe aortic stenosis ineligible for surgical aortic valve replacement (SAVR) or at increased perioperative risk. Due to continually emerging evidence, we performed a systematic review and meta-analysis comparing benefits and harms of TAVI, SAVR, medical therapy, and balloon aortic valvuloplasty.

METHODS: We searched MEDLINE, Embase, and Cochrane CENTRAL from 2002 to June 6, 2017. We dually screened abstracts and full-text articles for randomized controlled trials (RCTs) and propensity score-matched observational studies. Two investigators independently rated the risk of bias of included studies and determined the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). If data permitted, we performed meta-analyses using random- and fixed-effects models.

RESULTS: Out of 7755 citations, we included six RCTs (5862 patients) and 13 observational studies (6376 patients). In meta-analyses, patients treated with SAVR or TAVI had similar risks for mortality at 30 days (relative risk [RR] 1.05; 95% confidence interval [CI] 0.82 to 1.33) and 1 year (RR 1.02; 95% CI 0.93 to 1.13). TAVI had significantly lower risks for major bleeding but increased risks for major vascular complications, moderate or severe paravalvular aortic regurgitation, and new pacemaker implantation compared to SAVR. Comparing TAVI to medical therapy, mortality did not differ at 30 days but was significantly reduced at 1 year (RR 0.51; 95% CI 0.34 to 0.77).

CONCLUSIONS: Given similar mortality risks but different patterns of adverse events, the choice between TAVI and SAVR remains an individual one.

Original languageEnglish
Article number44
Pages (from-to)44
JournalSystematic Reviews
Volume8
Issue number1
DOIs
Publication statusPublished - 5 Feb 2019

Keywords

  • Aortic Valve Stenosis/surgery
  • Comparative Effectiveness Research
  • Humans
  • Meta-Analysis as Topic
  • Research Design
  • Systematic Reviews as Topic
  • Transcatheter Aortic Valve Replacement/methods
  • Transcatheter aortic valve implantation
  • Severe aortic stenosis
  • Systematic literature review

ASJC Scopus subject areas

  • Medicine (miscellaneous)

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