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TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTICVALVE REPLACEMENT IN AORTIC STENOSIS PATIENTS AT LOW TO MODERATE RISK OF SURGERY: A META-ANALYSIS OF 25,737 PATIENTS’ DATA
2096 JACC March 21, 2017 Volume 69, Issue 11
ACC International Conferences Best Posters TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTICVALVE REPLACEMENT IN AORTIC STENOSIS PATIENTS AT LOW TO MODERATE RISK OF SURGERY: A META-ANALYSIS OF 25,737 PATIENTS’ DATA Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: ACC International Conferences Best Posters Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease Presentation Number: 1050-458 Authors: Ahmed Elmaraezy, Abdelrahman Ibrahim Abushouk, Ammar Ismail, Farah Althaher, Ahmed Hesham Aboelmakarem, Ahmed Ramadan Abdallah, Moutaz Eltoomy, Hossam Mahmoud Hassan, Mohamed Mansour Saad, Aya Gamal Elmareazy, Ahmed Magdy Aboelfotoh, Mohammed Ahmed Shaheen, Osama Mahmoud Abdelaty, Soha Saad Ali, Moath Althaher, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, NOVA-Med Medical Research Association, Cairo, Egypt
Background: The efficacy of Transcatheter Aortic Valve Replacement (TAVR) has been established for aortic stenosis patients at high surgical risk. However, there is a lack in class one evidence about the efficacy and safety of TAVR in aortic stenosis patients at low to moderate risk of surgery. Therefore, we conducted a meta-analysis of published studies to provide a clear-cut evidence regarding the efficacy and safety of TAVR compared with surgical aortic value replacement (SAVR) for aortic stenosis patients at low to moderate surgical risk. Methods: A computer literature search of PubMed, Embase, Cochrane (Central), Scopus, and web of science was conducted using the relevant keywords. Records were screened for eligible studies and data were extracted to an online data extraction form. Outcomes of short term and long term (all-cause mortality) incidence of stroke, aortic regurgitation (AR), permanent pacemaker implantation (PPI), and vascular access complications were pooled as relative risk (RR) in the DerSimonian random effect model using Review Manager (version 5.3) software for windows.
Results: Fourteen studies (n=25737 patients) were included in the final analysis. There was no difference between TAVR and SAVR in terms of short-term (RR 1.12, 95% CI [0.87 to 1.45]) and long-term-all-cause mortality (RR 1.02, 95% CI [0.87 to 1.20]). In terms of safety, SAVR was associated with less complications than TAVR (stroke: RR 1.21, 95% CI [1.02 to 1.43], AR: RR 6.39, 95% CI [4.00 to 10.21], PPI: RR 3.49, 95% CI [1.93 to 6.30], and vascular access complications: RR 10.14, 95% CI [2.44 to 42.19]).
Conclusions: TARV was associated with similarly low rates of short and long term all-cause mortality compared to SAVR in aortic stenosis patients at low to moderate risk of surgery. However, due to the higher incidence of stroke, aortic regurgitation, permanent pacemaker implantation, and vascular access complications in the TARV group, we do not recommend this approach to be performed in aortic stenosis patients at low to moderate surgical risk.
ACC International Conferences Best Posters TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTICVALVE REPLACEMENT IN AORTIC STENOSIS PATIENTS AT LOW TO MODERATE RISK OF SURGERY: A META-ANALYSIS OF 25,737 PATIENTS’ DATA Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: ACC International Conferences Best Posters Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease Presentation Number: 1050-458 Authors: Ahmed Elmaraezy, Abdelrahman Ibrahim Abushouk, Ammar Ismail, Farah Althaher, Ahmed Hesham Aboelmakarem, Ahmed Ramadan Abdallah, Moutaz Eltoomy, Hossam Mahmoud Hassan, Mohamed Mansour Saad, Aya Gamal Elmareazy, Ahmed Magdy Aboelfotoh, Mohammed Ahmed Shaheen, Osama Mahmoud Abdelaty, Soha Saad Ali, Moath Althaher, Faculty of Medicine, Al-Azhar University, Cairo, Egypt, NOVA-Med Medical Research Association, Cairo, Egypt
Background: The efficacy of Transcatheter Aortic Valve Replacement (TAVR) has been established for aortic stenosis patients at high surgical risk. However, there is a lack in class one evidence about the efficacy and safety of TAVR in aortic stenosis patients at low to moderate risk of surgery. Therefore, we conducted a meta-analysis of published studies to provide a clear-cut evidence regarding the efficacy and safety of TAVR compared with surgical aortic value replacement (SAVR) for aortic stenosis patients at low to moderate surgical risk. Methods: A computer literature search of PubMed, Embase, Cochrane (Central), Scopus, and web of science was conducted using the relevant keywords. Records were screened for eligible studies and data were extracted to an online data extraction form. Outcomes of short term and long term (all-cause mortality) incidence of stroke, aortic regurgitation (AR), permanent pacemaker implantation (PPI), and vascular access complications were pooled as relative risk (RR) in the DerSimonian random effect model using Review Manager (version 5.3) software for windows.
Results: Fourteen studies (n=25737 patients) were included in the final analysis. There was no difference between TAVR and SAVR in terms of short-term (RR 1.12, 95% CI [0.87 to 1.45]) and long-term-all-cause mortality (RR 1.02, 95% CI [0.87 to 1.20]). In terms of safety, SAVR was associated with less complications than TAVR (stroke: RR 1.21, 95% CI [1.02 to 1.43], AR: RR 6.39, 95% CI [4.00 to 10.21], PPI: RR 3.49, 95% CI [1.93 to 6.30], and vascular access complications: RR 10.14, 95% CI [2.44 to 42.19]).
Conclusions: TARV was associated with similarly low rates of short and long term all-cause mortality compared to SAVR in aortic stenosis patients at low to moderate risk of surgery. However, due to the higher incidence of stroke, aortic regurgitation, permanent pacemaker implantation, and vascular access complications in the TARV group, we do not recommend this approach to be performed in aortic stenosis patients at low to moderate surgical risk.