Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta‐analysis

Dowling, Cameron; Seshasai, Sreenivasa Rao Kondapally; Firoozi, Sami; Brecker, Stephen

doi:10.1002/ccd.28504

Cited by 13 publications

(13 citation statements)

References 49 publications

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“…Due to significant advancements in transcatheter aortic valve replacement (TAVR) safety, efficacy, and noninferiority compared to surgical aortic valve replacement (SAVR), the number of TAVR procedures is rising [ 1 , 2 , 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A detailed scrutiny of individual patient data, conducted via a meta-analysis derived from randomized clinical trials, offers a nuanced comparison between TAVR and SAVR. The comprehensive evaluation conducted at the one-year milestone discerns a distinct advantage for TAVR, manifesting as a lower risk of death, disabling stroke, and the composite endpoint of death or disabling stroke, positioning TAVR as a compelling alternative to SAVR [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Demirel,

Rothenbühler,

Huber

et al. 2024

JCM

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Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998–1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927–0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99–1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Demirel,

Rothenbühler,

Huber

et al. 2024

JCM

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“…Over the past two decades, TAVR has undergone remarkable evolution, marked by substantial enhancements in safety, efficacy, and procedural outcomes. These advancements led to a notable rise in the utilization of TAVR procedures, encompassing a broader spectrum of patients, including those deemed to be at intermediate or low surgical risk [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…These studies furnish compelling evidence of TAVR's superiority over surgical aortic valve replacement (SAVR), particularly in terms of clinical endpoints such as mortality, disabling stroke, and composite outcomes. Notably, the one-year evaluation reveals a tangible advantage for TAVR, characterized by a reduced risk profile compared to SAVR, thus positioning it as a compelling alternative [5]. 15 Delving deeper into the landscape of clinical outcomes, longitudinal studies have provided further insights into the comparative efficacy of TAVR and SAVR, particularly among patients with severe aortic stenosis and intermediate surgical risk.…”

Section: Introductionmentioning

confidence: 99%

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

Demirel,

Halavina,

Hamzaraj

et al. 2024

JCM

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Background: Transcatheter aortic valve replacement (TAVR) has evolved as first-line therapy for severe aortic valve stenosis (AS), with pre-procedural computed tomography (CT) providing critical anatomical information. While primarily used for anatomical planning, TAVR-CT also offers an opportunity to assess low bone mineral density (BMD), a known indicator of frailty. Despite this, the prognostic role of BMD in TAVR patients remains unknown. This study aimed to evaluate BMD on routine TAVR-CT and its impact on long-term survival. Methods: In this retrospective study, 770 consecutive TAVR patients (mean age 80.7 ± 6.7 years, 54.0% males) between November 2015 and March 2022 were included. BMD was measured from a single axial image at the thoracic vertebral level on unenhanced CT scans. Cox regression models assessed the impact of BMD on mortality, and Restricted Cubic Spline models identified potential mortality thresholds. Results: The mean BMD value, as measured on non-contrast CT, was 147.5 ± 5.4 Hounsfield units, demonstrating a noteworthy association with mortality (adjusted hazard ratio per 100 HU decrease: 1.27 [95% CI: 1.01–1.59], p = 0.041). Restricted cubic spline analysis indicated that BMD below 200 HU was linked to a substantial increase in mortality risk. Upon crude Cox regression analysis, every 100 HU decrease was associated with a 32% increase in risk for death (HR 1.32 [95%CI: 1.068–1.65)], p = 0.010). Conclusions: In conclusion, low BMD on TAVR-CT is independently associated with reduced survival, suggesting its potential as a tool for comprehensive frailty assessment and improved risk prediction in TAVR patients.

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“…Transcatheter aortic valve replacement (TAVR) is associated with improved clinical outcomes, when compared to surgery, 1 and has now become the dominant therapy for treating patients with severe aortic stenosis. 2 However, TAVR is associated with a higher incidence of left bundle branch block (LBBB) 3 and permanent pacemaker (PPM) implantation, 4,5 than surgery, and patients who develop these complications are at a higher risk for adverse clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves

Dowling¹,

Gooley²,

McCormick³

et al. 2022

Structural Heart

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Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta‐analysis

Abstract: Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: a reconstructed individual patient data meta-analysis Short Title: Dowling et al. TAVR vs. Surgery for Severe AS.

Cited by 13 publications

References 49 publications

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients

Low Bone Mineral Density on Computed Tomography: Association with Poor Survival after Transcatheter Aortic Valve Replacement

Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves

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