Comparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs

Abstract

BackgroundThis study aims to compare valve durability between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR).MethodsWe conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The primary outcome was structural valve deterioration (SVD). Secondary outcomes were bioprosthetic valve failure, reintervention, effective orifice area (EOA), mean pressure gradient, and moderate–severe aortic regurgitation (AR, transvalvular and/or paravalvular).ResultsTwenty-five publications from seven RCTs consisting of 7,970 patients were included in the analysis with follow-up ranges of 2–8 years. No significant difference was found between the two groups with regard to SVD [odds ratio (OR) 0.72; 95% CI: 0.25–2.12]. The TAVI group was reported to exhibit a statistically significant higher risk of reintervention (OR 2.03; 95% CI: 1.34–3.05) and a moderate–severe AR (OR 6.54; 95% CI: 3.92–10.91) compared with the SAVR group. A trend toward lower mean pressure gradient in the TAVI group [(mean difference (MD) −1.61; 95% CI: −3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08–0.31) was noted.ConclusionThe present data indicate that TAVI provides a comparable risk of SVD with favorable hemodynamic profile compared with SAVR. However, the higher risk of significant AR and reintervention was demonstrated.Systematic Review RegistrationPROSPERO (CRD42022363060).

Successful Treatment of Malignant Lymphoma Following Transcatheter Aortic Valve Replacement: A Case Report

“…Compared with surgical aortic valves, evidence regarding the long-term durability of transcatheter aortic valves is limited. A recent meta-analysis of randomized controlled trials (RCTs) with follow-up periods of two to eight years found no significant difference in structural valve deterioration between SAVR and TAVR groups (10). However, the TAVR group had a significantly higher risk of reintervention [odds ratio (OR) 2.03; 95% confidence interval (CI): 1.34-3.05] and of moderate-severe aortic regurgitation (OR 6.54; 95% CI: 3.92-10.91) than the SAVR group (10).…”

“…A recent meta-analysis of randomized controlled trials (RCTs) with follow-up periods of two to eight years found no significant difference in structural valve deterioration between SAVR and TAVR groups (10). However, the TAVR group had a significantly higher risk of reintervention [odds ratio (OR) 2.03; 95% confidence interval (CI): 1.34-3.05] and of moderate-severe aortic regurgitation (OR 6.54; 95% CI: 3.92-10.91) than the SAVR group (10). Regular long-term medical follow-up to evaluate the valve status is indicated for patients undergoing TAVR.…”