An updated meta-analysis of TAVR in patients at intermediate risk for SAVR

Mohamad Lazkani, Nirmal Singh, Carol Howe, Nachiket Patel, Modesto J. Colón, Mark Tasset, Orazio Amabile, Michael Morris, H. Kenith Fang, Ashish Pershad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been approved for use in patients with severe aortic stenosis at intermediate, high and extreme surgical risk. This meta-analysis was performed to assess the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) in intermediate risk patients. Methods: We searched PubMed, EMBASE, Web of science, and the Cochrane Central Register of Controlled Trials databases for studies comparing TAVR versus SAVR in patients at intermediate surgical risk, with a mean Society of Thoracic Surgeon score of 3–8% or a mean logistic European risk score of 10–20%. The primary endpoint was to assess the efficacy of TAVR compared to SAVR, defined as all-cause and cardiovascular mortality at 30-days, 1-year, and ≥2 years of follow-up. Secondary endpoints were the safety profile, comprising of cerebrovascular events, myocardial infarctions, permanent pacemaker placement, new onset atrial fibrillation, aortic regurgitation, vascular complications, major bleeding and acute kidney injury. Results: This is the largest and most contemporary meta-analysis of 5647 intermediate risk patients in eleven studies published to date. There were no statistically significant differences in all-cause and cardiac mortality at 30 days, 1- year and >2-years of follow up. Acute kidney injury and atrial fibrillation occurred more frequently in patients treated with SAVR and permanent pacemaker implantation and aortic insufficiency were more frequent in patients treated with TAVR. Conclusion: This meta-analysis suggests that for intermediate risk patients with severe aortic stenosis, TAVR has similar efficacy as SAVR but with a different adverse event profile.

Original languageEnglish (US)
Pages (from-to)57-69
Number of pages13
JournalCardiovascular Revascularization Medicine
Volume20
Issue number1
DOIs
StatePublished - Jan 2019

Fingerprint

Aortic Valve
Surgical Instruments
Meta-Analysis
Aortic Valve Stenosis
Acute Kidney Injury
Atrial Fibrillation
Safety
Aortic Valve Insufficiency
Mortality
Transcatheter Aortic Valve Replacement
PubMed
Blood Vessels
Thorax
Myocardial Infarction
Databases
Hemorrhage

Keywords

  • Aortic stenosis
  • Intermediate surgical risk
  • SAVR
  • TAVR

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. / Lazkani, Mohamad; Singh, Nirmal; Howe, Carol; Patel, Nachiket; Colón, Modesto J.; Tasset, Mark; Amabile, Orazio; Morris, Michael; Fang, H. Kenith; Pershad, Ashish.

In: Cardiovascular Revascularization Medicine, Vol. 20, No. 1, 01.2019, p. 57-69.

Research output: Contribution to journalArticle

Lazkani, M, Singh, N, Howe, C, Patel, N, Colón, MJ, Tasset, M, Amabile, O, Morris, M, Fang, HK & Pershad, A 2019, 'An updated meta-analysis of TAVR in patients at intermediate risk for SAVR', Cardiovascular Revascularization Medicine, vol. 20, no. 1, pp. 57-69. https://doi.org/10.1016/j.carrev.2018.04.001
Lazkani, Mohamad ; Singh, Nirmal ; Howe, Carol ; Patel, Nachiket ; Colón, Modesto J. ; Tasset, Mark ; Amabile, Orazio ; Morris, Michael ; Fang, H. Kenith ; Pershad, Ashish. / An updated meta-analysis of TAVR in patients at intermediate risk for SAVR. In: Cardiovascular Revascularization Medicine. 2019 ; Vol. 20, No. 1. pp. 57-69.
@article{1457d70a71a1458fa5605325284605aa,
title = "An updated meta-analysis of TAVR in patients at intermediate risk for SAVR",
abstract = "Background: Transcatheter aortic valve replacement (TAVR) has been approved for use in patients with severe aortic stenosis at intermediate, high and extreme surgical risk. This meta-analysis was performed to assess the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) in intermediate risk patients. Methods: We searched PubMed, EMBASE, Web of science, and the Cochrane Central Register of Controlled Trials databases for studies comparing TAVR versus SAVR in patients at intermediate surgical risk, with a mean Society of Thoracic Surgeon score of 3–8{\%} or a mean logistic European risk score of 10–20{\%}. The primary endpoint was to assess the efficacy of TAVR compared to SAVR, defined as all-cause and cardiovascular mortality at 30-days, 1-year, and ≥2 years of follow-up. Secondary endpoints were the safety profile, comprising of cerebrovascular events, myocardial infarctions, permanent pacemaker placement, new onset atrial fibrillation, aortic regurgitation, vascular complications, major bleeding and acute kidney injury. Results: This is the largest and most contemporary meta-analysis of 5647 intermediate risk patients in eleven studies published to date. There were no statistically significant differences in all-cause and cardiac mortality at 30 days, 1- year and >2-years of follow up. Acute kidney injury and atrial fibrillation occurred more frequently in patients treated with SAVR and permanent pacemaker implantation and aortic insufficiency were more frequent in patients treated with TAVR. Conclusion: This meta-analysis suggests that for intermediate risk patients with severe aortic stenosis, TAVR has similar efficacy as SAVR but with a different adverse event profile.",
keywords = "Aortic stenosis, Intermediate surgical risk, SAVR, TAVR",
author = "Mohamad Lazkani and Nirmal Singh and Carol Howe and Nachiket Patel and Col{\'o}n, {Modesto J.} and Mark Tasset and Orazio Amabile and Michael Morris and Fang, {H. Kenith} and Ashish Pershad",
year = "2019",
month = "1",
doi = "10.1016/j.carrev.2018.04.001",
language = "English (US)",
volume = "20",
pages = "57--69",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - An updated meta-analysis of TAVR in patients at intermediate risk for SAVR

AU - Lazkani, Mohamad

AU - Singh, Nirmal

AU - Howe, Carol

AU - Patel, Nachiket

AU - Colón, Modesto J.

AU - Tasset, Mark

AU - Amabile, Orazio

AU - Morris, Michael

AU - Fang, H. Kenith

AU - Pershad, Ashish

PY - 2019/1

Y1 - 2019/1

N2 - Background: Transcatheter aortic valve replacement (TAVR) has been approved for use in patients with severe aortic stenosis at intermediate, high and extreme surgical risk. This meta-analysis was performed to assess the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) in intermediate risk patients. Methods: We searched PubMed, EMBASE, Web of science, and the Cochrane Central Register of Controlled Trials databases for studies comparing TAVR versus SAVR in patients at intermediate surgical risk, with a mean Society of Thoracic Surgeon score of 3–8% or a mean logistic European risk score of 10–20%. The primary endpoint was to assess the efficacy of TAVR compared to SAVR, defined as all-cause and cardiovascular mortality at 30-days, 1-year, and ≥2 years of follow-up. Secondary endpoints were the safety profile, comprising of cerebrovascular events, myocardial infarctions, permanent pacemaker placement, new onset atrial fibrillation, aortic regurgitation, vascular complications, major bleeding and acute kidney injury. Results: This is the largest and most contemporary meta-analysis of 5647 intermediate risk patients in eleven studies published to date. There were no statistically significant differences in all-cause and cardiac mortality at 30 days, 1- year and >2-years of follow up. Acute kidney injury and atrial fibrillation occurred more frequently in patients treated with SAVR and permanent pacemaker implantation and aortic insufficiency were more frequent in patients treated with TAVR. Conclusion: This meta-analysis suggests that for intermediate risk patients with severe aortic stenosis, TAVR has similar efficacy as SAVR but with a different adverse event profile.

AB - Background: Transcatheter aortic valve replacement (TAVR) has been approved for use in patients with severe aortic stenosis at intermediate, high and extreme surgical risk. This meta-analysis was performed to assess the safety and efficacy of TAVR compared to surgical aortic valve replacement (SAVR) in intermediate risk patients. Methods: We searched PubMed, EMBASE, Web of science, and the Cochrane Central Register of Controlled Trials databases for studies comparing TAVR versus SAVR in patients at intermediate surgical risk, with a mean Society of Thoracic Surgeon score of 3–8% or a mean logistic European risk score of 10–20%. The primary endpoint was to assess the efficacy of TAVR compared to SAVR, defined as all-cause and cardiovascular mortality at 30-days, 1-year, and ≥2 years of follow-up. Secondary endpoints were the safety profile, comprising of cerebrovascular events, myocardial infarctions, permanent pacemaker placement, new onset atrial fibrillation, aortic regurgitation, vascular complications, major bleeding and acute kidney injury. Results: This is the largest and most contemporary meta-analysis of 5647 intermediate risk patients in eleven studies published to date. There were no statistically significant differences in all-cause and cardiac mortality at 30 days, 1- year and >2-years of follow up. Acute kidney injury and atrial fibrillation occurred more frequently in patients treated with SAVR and permanent pacemaker implantation and aortic insufficiency were more frequent in patients treated with TAVR. Conclusion: This meta-analysis suggests that for intermediate risk patients with severe aortic stenosis, TAVR has similar efficacy as SAVR but with a different adverse event profile.

KW - Aortic stenosis

KW - Intermediate surgical risk

KW - SAVR

KW - TAVR

UR - http://www.scopus.com/inward/record.url?scp=85046814059&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046814059&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2018.04.001

DO - 10.1016/j.carrev.2018.04.001

M3 - Article

C2 - 29748086

AN - SCOPUS:85046814059

VL - 20

SP - 57

EP - 69

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

IS - 1

ER -