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Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients at low and intermediate risk: A risk specific meta-analysis of randomized controlled trials
- Source :
- PLoS ONE, PLoS ONE, Vol 14, Iss 9, p e0221922 (2019)
- Publication Year :
- 2019
-
Abstract
- Background Transcatheter aortic valve implantation (TAVI) is an option for treatment for patients with severe aortic stenosis who are at high risk for death with surgical aortic valve replacement (SAVR). It is unknown whether TAVI can be safely introduced to intermediate- and low-risk patients. Objective To compare the efficacy and safety of TAVI and SAVR in patients with intermediate- and low-surgical risk. Data sources Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2019. Study selection We included randomized controlled trials comparing TAVI with SAVR in patients with intermediate- and low-surgical risk. Data extraction Meta-analyses were conducted using random-effects models to calculate risk ratios (RR) with corresponding 95% confidence interval (CI). Two independent reviewers completed citation screening, data abstraction, and risk assessment. Primary outcome was a composite of all-cause mortality or disabling stroke at 12 months. Data synthesis A total of 5 trials randomizing 6390 patients were included. In patients with low risk, TAVI was associated with a significant reduction in the composite of all-cause mortality or disabling stroke compared with SAVR (RR, 0.56; 95%CI, 0.40-0.79; I2 = 0%). This benefit was not replicated in patients with intermediate risk (RR, 0.96; 95% CI, 0.80-1.15; I2 = 0%). Similar results were seen separately in all-cause mortality and disabling stroke when TAVI was compared with SAVR. Conclusion For patients with severe aortic stenosis who were at low risk for death from surgery, TAVI achieved superior clinical outcomes compared to SAVR; however, these benefits were not seen in those with intermediate risk. This information may inform discussions about deciding between SAVR and TAVI for patients with low to intermediate risk separately.
- Subjects :
- Cardiovascular Procedures
030204 cardiovascular system & hematology
Pathology and Laboratory Medicine
law.invention
0302 clinical medicine
Mathematical and Statistical Techniques
Randomized controlled trial
Aortic valve replacement
law
Risk Factors
Odds Ratio
Medicine and Health Sciences
030212 general & internal medicine
Stroke
Randomized Controlled Trials as Topic
Heart Valve Prosthesis Implantation
Stenosis
Multidisciplinary
Statistics
Heart
Metaanalysis
Research Assessment
Treatment Outcome
Meta-analysis
Aortic Valve
Heart Valve Prosthesis
Physical Sciences
Cardiology
Research Reporting Guidelines
Medicine
Safety
Anatomy
Risk assessment
Aortic Valve Replacement
Research Article
medicine.medical_specialty
Drug Research and Development
Death Rates
Science
Surgical and Invasive Medical Procedures
Research and Analysis Methods
Risk Assessment
Transcatheter Aortic Valve Replacement
03 medical and health sciences
Signs and Symptoms
Population Metrics
Diagnostic Medicine
Internal medicine
medicine
Humans
Clinical Trials
Statistical Methods
Pharmacology
Population Biology
business.industry
Biology and Life Sciences
Odds ratio
Aortic Valve Stenosis
medicine.disease
Randomized Controlled Trials
Relative risk
Cardiovascular Anatomy
Clinical Medicine
business
Mathematics
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 14
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....aa981f1ba0d665bfe7646e597cad16db