Outcomes of surgical aortic valve replacement in moderate risk patients: Implications for determination of equipoise in the transcatheter era

Iturra, Sebastián; Suri, Rakesh M.; Greason, Kevin L.; Stulak, John M.; Burkhart, Harold M.; Dearani, Joseph A.; Schaff, Hartzell V.

doi:10.1016/j.jtcvs.2013.08.036

Cited by 29 publications

(15 citation statements)

References 19 publications

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“…Euroscore (mean <20%) was used only if the STS score was not available. Inclusion was restricted to comparison studies only and studies with isolated data from only one of the two interventions were not included (13,14,18,19). We included all studies irrespective of the type of TAVR valve and the route of vascular access.…”

Section: Study Characteristicsmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Arora

Misenheimer

Jones

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons.Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR). Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.

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Section: Study Characteristicsmentioning

confidence: 99%

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Arora

Misenheimer

Jones

et al. 2016

Cardiovasc. Diagn. Ther.

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“…(32–34) COPD has also been shown to be an independent risk factor for mortality among patients treated with surgical AVR. (35)…”

Section: Medical Comorbiditiesmentioning

confidence: 99%

Multimorbidity in Older Adults with Aortic Stenosis

Lindman

Patel

2016

Clinics in Geriatric Medicine

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Synopsis Aortic stenosis is a disease of older adults, many of whom have associated medical and aging-related comorbidities. With the aging of the population and the emergence of transcatheter aortic valve replacement as a treatment option, clinicians will increasingly be confronted with the intersection of aortic stenosis and multimorbidity. This convergence makes the evaluation, management, and treatment of aortic stenosis more complex in multiple ways. To optimize patient-centered clinical outcomes, new treatment paradigms are needed that recognize the import and influence of multimorbidity on patients with aortic stenosis. We review the prevalence of medical and aging-related comorbidities in patients with aortic stenosis, their impact on outcomes, and discuss how they influence management and treatment decisions.

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“…Prior studies have also focused on evaluating moderate-risk patients. Iturra and colleagues [10] evaluated an institutional cohort of 502 patients undergoing AVR from 2002 to 2011. With a similar preoperative PROM as our study cohort, they identified an observed mortality rate of 2.8%.…”

Section: Commentmentioning

confidence: 99%

Aortic Valve Replacement in the Moderately Elevated Risk Patient: A Population-Based Analysis of Outcomes

Patel

Likosky

Pruitt

et al. 2016

The Annals of Thoracic Surgery

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Outcomes of surgical aortic valve replacement in moderate risk patients: Implications for determination of equipoise in the transcatheter era

Cited by 29 publications

References 19 publications

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Multimorbidity in Older Adults with Aortic Stenosis

Aortic Valve Replacement in the Moderately Elevated Risk Patient: A Population-Based Analysis of Outcomes

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