Meta-Analysis Compares TAVR and SAVR in Low-Surgical-Risk Patients
February 9, 2018—Online in Catheterization and Cardiovascular Interventions, Guy Witberg, MD, et al published findings from a study on transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients who are at low surgical risk.
The investigators conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) that compared TAVR and SAVR in the low-risk population. The study's primary outcome was all-cause mortality. The secondary outcomes included stroke, myocardial infarction, bleeding, and various procedural complications.
The investigators explained that the background of the study is that although TAVR is officially indicated for high-risk aortic stenosis patients, the procedure is increasingly being performed in patients who are not at high surgical risk, including a substantial number of low-risk patients. However, data on the benefit of TAVR in this patient population is limited.
As summarized in Catheterization and Cardiovascular Interventions, the review and analysis included six studies (two RCTs and four PSM studies) composed of a total of 3,484 patients in which follow-up ranged from 3 months to 3 years (median, 2 years).
The investigators found that short-term mortality was similar with TAVR and SAVR (2.2% vs 2.6%; relative risk [RR], 0.89; 95% confidence interval [CI], 0.56–1.41; P = .62); however, TAVR was associated with increased risk for intermediate-term mortality (17.2% vs 12.7%; RR, 1.45; 95% CI, 1.11–1.89; P = .006). In terms of periprocedural complications, TAVR was associated with reduced risk for bleeding and renal failure and an increase in vascular complications and pacemaker implantation, reported the investigators.
In patients who are at low surgical risk, TAVR seems to be associated with increased mortality risk; therefore, until more data are available for this population, SAVR should remain the treatment of choice for these patients, concluded the investigators in Catheterization and Cardiovascular Interventions.