Transcatheter aortic valve implantation versus surgical aortic valve
replacement in low-risk patients: A meta-analysis based on a 2-year
follow-up
Abstract
Background: Previous studies have shown that transcatheter
aortic valve implantation (TAVI) is the best alternative therapy to
surgical aortic valve replacement (SAVR) in high-risk surgical patients
with aortic stenosis (AS). However, it is not clear whether TAVI can be
utilised in low-risk surgical patients with AS. This study aimed to
evaluate the safety and efficacy of TAVI in low-risk patients.
Methods: From the outset of our initiative until June 2021,
PubMed, EMBASE, and Cochrane were thoroughly searched, yielding the
selection of 3 randomised controlled trials including 2633 patients with
AS, to assess outcome measures at distinct follow-up time periods.
Results: The mean Society of Thoracic Surgeons Predicted Risk
of Mortality score of patients was 2.2. At the 30-day and 1-year
follow-up, TAVI was associated with a lower incidence of all-cause
mortality, cardiovascular mortality, acute kidney injury (stage 2 or 3),
life-threatening or significant bleeding, and new atrial fibrillation
(NAF), but an increased risk of permanent pacemaker implantation. At the
2-year follow-up, TAVI only had an advantage in NAF (RR, 0.27; 95% CI,
0.14–0.51; P<0.0001) without any significant difference in any of the
other outcome measures. Conclusions: For low-risk surgical
patients with AS, the efficacy of TAVI was superior to that of SAVR by
the 30-day and 1-year follow-up. This was most evident by the 2-year
follow-up, except for the advantages of NAF, with no other significant
differences.