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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Cardiovasc+Diagn+Ther
2016 ; 6
(3
): 241-9
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Transcatheter versus surgical aortic valve replacement in intermediate risk
patients: a meta-analysis
#MMPMID27280087
Arora S
; Misenheimer JA
; Jones W
; Bahekar A
; Caughey M
; Ramm CJ
; Caranasos TG
; Yeung M
; Vavalle JP
Cardiovasc Diagn Ther
2016[Jun]; 6
(3
): 241-9
PMID27280087
show ga
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been approved in
patients with high or prohibited surgical risk for surgery for treatment of
severe symptomatic aortic stenosis. Prospective studies examining the benefits of
TAVR in intermediate risk patients are ongoing. Other smaller studies including
lower risk patients have been conducted, but further meta-analysis of these
studies is required to draw more broad comparisons. METHODS: A Medline search was
conducted using standard methodology to search for clinical trials and
observational studies including intermediate risk patients. We limited our
meta-analysis to studies matching patient populations by propensity scores or
randomization and examined clinical outcomes between TAVR and surgical aortic
valve replacement (SAVR). RESULTS: Analysis of the TAVR and SAVR cohorts revealed
no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57,
1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards
benefit with TAVR was noted in terms of neurological events and myocardial
infarction (MI) without statistical significance. A statistically significant
decrease in risk of post-procedural acute renal failure in the TAVR group [OR
(95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate
of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)].
CONCLUSIONS: We conclude that in intermediate risk patients undergoing aortic
valve replacement, the risk of mortality, neurological outcomes, and MI do not
appear to be significantly different between TAVR and SAVR. However, there
appears to be a significant reduction in risk of acute renal failure at the
expense of an increased risk of requiring a permanent pacemaker in low and
intermediate risk patients undergoing TAVR compared to SAVR.
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