REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 February;61(1):107-16

DOI: 10.23736/S0021-9509.19.11030-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

A meta-analysis of ≥5-year mortality after transcatheter versus surgical aortic valve replacement

Hisato TAKAGI ^{1, 2} ✉, Yosuke HARI ^{1, 2}, Kouki NAKASHIMA ^{1, 2}, Toshiki KUNO ³, Tomo ANDO ⁴, on behalf of the All-Literature Investigation of Cardiovascular Evidence (ALICE) Group

¹ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; ² Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan; ³ Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA; ⁴ Department of Cardiology, Detroit Medical Center, Detroit, MI, USA

INTRODUCTION: It remains unclear whether long-term survival is superior following transcatheter aortic valve implantation (TAVI) than following surgical aortic valve replacement (SAVR). We performed a meta-analysis of mortality with ≥5-year follow-up in randomized controlled trials (RCTs) and propensity-score matched (PSM) studies of TAVI versus SAVR.
EVIDENCE ACQUISITION: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2019. Eligible studies were RCTs or PSM studies of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting all-cause mortality with ≥5-year follow-up as an outcome. A hazard ratio of mortality for TAVI versus SAVR was extracted from each individual study.
EVIDENCE SYNTHESIS: Our search identified 3 RCTs and 7 PSM studies enrolling 5498 patients. A pooled analysis of all 10 studies demonstrated a statistically significant 38% increase in mortality with TAVI relative to SAVR. A subgroup meta-analysis showed no statistically significant difference between TAVI and AVR in RCTs and a statistically significant 68% increase with TAVI relative to SAVR in PSM studies.
CONCLUSIONS: On the basis of a meta-analysis of 7 PSM studies, TAVI is associated with greater all-cause mortality with ≥5-year follow-up than SAVR. However, another meta-analysis of 3 RCTs suggests no difference in mortality between TAVI and SAVR.

KEY WORDS: Meta-analysis; Randomized controlled trial; Transcatheter aortic valve replacement; Surgery