Affordable Access

deepdyve-link
Publisher Website

Meta-analysis of transfemoral TAVR versus surgical aortic valve replacement.

Authors
  • Arora, Sameer1
  • Vaidya, Satyanarayana R2
  • Strassle, Paula D3, 4
  • Misenheimer, Jacob A1, 5
  • Rhodes, Jeremy A6
  • Ramm, Cassandra J1
  • Wheeler, Evan N6
  • Caranasos, Thomas G4
  • Cavender, Matthew A1
  • Vavalle, John P1
  • 1 Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, 27599-7075.
  • 2 Division of Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, North Carolina, 28304.
  • 3 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, 27599-7400.
  • 4 Department of Surgery, UNC School of Medicine, Chapel Hill, North Carolina, 27599-7050.
  • 5 Division of Cardiology, The Medical College of Georgia at Augusta University, Augusta, Georgia, 30912. , (Georgia)
  • 6 Campbell University School of Osteopathic Medicine, Lillington, North Carolina, 27546.
Type
Published Article
Journal
Catheterization and Cardiovascular Interventions
Publisher
Wiley (John Wiley & Sons)
Publication Date
Mar 01, 2018
Volume
91
Issue
4
Pages
806–812
Identifiers
DOI: 10.1002/ccd.27357
PMID: 29068166
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

In the recently concluded PARTNER 2 trial, TF-TAVR cohort was shown to have lower risks of death or disabling strokes as compared to SAVR, whereas the outcomes with transthoracic TAVR were comparable with SAVR. We searched PubMed, EMBASE, Web of Science, and Google Scholar for all comparison studies between TAVR and SAVR and mortality as an outcome, irrespective of surgical risk. Randomized controlled trials and propensity-score-matched cohort studies that used a transfemoral approach exclusively or stratified results by route of access and reported data for TF-TAVR patients were eligible for inclusion. Outcomes of interest included 30-day and 1-year mortality, and 30-day complications. If significant heterogeneity was found in the random effects meta-analyses, a sensitivity analysis which individually removed each study was conducted. Seven studies reported results on TF-TAVR. Compared with SAVR, TF-TAVR had comparable 30-day mortality (RR 0.79, 95% CI 0.58, 1.06), 1-year mortality (RR 0.91, 95% CI 0.78, 1.08) and 30-day risk of bleeding (RR 0.70, 95% CI 0.31, 1.57). However, TF-TAVR was associated with lower 30-day risks of atrial fibrillation (RR 0.28, 95% CI 0.17, 0.45), acute kidney injury (RR 0.38, 95% CI 0.20, 0.71), and myocardial infarction (RR 0.41, 95% CI 0.23, 0.75) at a cost of higher incidences of vascular complications (RR 6.10, 95% CI 2.92, 12.73) and pacemaker implantations (RR 3.29, 95% CI 1.41, 7.65). TF-TAVR is associated with lower 30-day risks of myocardial infarction compared to SAVR. Further studies are required to investigate the role of myocardial injury on overall TF-TAVR outcomes. © 2017 Wiley Periodicals, Inc.

Report this publication

Statistics

Seen <100 times