Article type
Year
Abstract
Background: Since transcatheter aortic valve implantation (TAVI) was introduced as an alternative option to surgical aortic valve replacement (SAVR) for severe aortic valve stenosis patients with a high surgical risk or inoperable cases, the number of TAVIs performed has increased markedly. However, TAVI performance in intermediate and low surgical risk patients is an issue in some countries.
Objectives:
Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative option to surgical aortic valve replacement (SAVR) for severe aortic valve stenosis patients. This study aimed to summarize current evidence of the clinical effectiveness and safety of TAVI.
Methods:
A literature search of databases was conducted such as Ovid-MEDLINE, Ovid-EMBASE, and Cochrane library for relevant publications between 2002 and May 2019. Firstly, we found systematic reviews and identified randomized trials. Then, we searched PubMed and clinicaltrials.gov for updates of newly published RCTs. For assessment of methodological quality, a measurement tool to assess systematic reviews (AMSTAR) and Cochrane risk of bias were used. We qualitatively summarized each systematic review and performed a meta-analysis of randomized trials which were included in the systematic reviews.
Results:
We identified and summarized available evidence from 40 systematic reviews and 8 multicenter trials. In the meta-analysis of TAVI versus SAVR, high risk and intermediate risk groups did not show differences in outcomes of all-cause mortality, cardiovascular mortality, stroke, and myocardial infarction rates between TAVI and SAVR. However, TAVI had a tendency toward higher rates of paravalvular regurgitation, but lower rates of acute kidney injury. In the low risk group, TAVI showed lower stroke rates in the short-term and mid-term.
Conclusions:
There was no difference between TAVI and SAVR across the surgical risk criteria in the all-cause mortality, cardiovascular mortality, and myocardial infarction rates. However, in the low risk group the stroke rate was lower in the short-term and mid-term for TAVI, which had a higher tendency toward paravalvular regurgitation rates but lower acute kidney injury rate, except for the low risk group.
Patient or healthcare consumer involvement: None
Attached Figure: Forest plots of all-cause mortality of RCTs; (A) short-term all-cause mortality (B) mid-term all-cause mortality (C) long-term all-cause mortality
Objectives:
Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative option to surgical aortic valve replacement (SAVR) for severe aortic valve stenosis patients. This study aimed to summarize current evidence of the clinical effectiveness and safety of TAVI.
Methods:
A literature search of databases was conducted such as Ovid-MEDLINE, Ovid-EMBASE, and Cochrane library for relevant publications between 2002 and May 2019. Firstly, we found systematic reviews and identified randomized trials. Then, we searched PubMed and clinicaltrials.gov for updates of newly published RCTs. For assessment of methodological quality, a measurement tool to assess systematic reviews (AMSTAR) and Cochrane risk of bias were used. We qualitatively summarized each systematic review and performed a meta-analysis of randomized trials which were included in the systematic reviews.
Results:
We identified and summarized available evidence from 40 systematic reviews and 8 multicenter trials. In the meta-analysis of TAVI versus SAVR, high risk and intermediate risk groups did not show differences in outcomes of all-cause mortality, cardiovascular mortality, stroke, and myocardial infarction rates between TAVI and SAVR. However, TAVI had a tendency toward higher rates of paravalvular regurgitation, but lower rates of acute kidney injury. In the low risk group, TAVI showed lower stroke rates in the short-term and mid-term.
Conclusions:
There was no difference between TAVI and SAVR across the surgical risk criteria in the all-cause mortality, cardiovascular mortality, and myocardial infarction rates. However, in the low risk group the stroke rate was lower in the short-term and mid-term for TAVI, which had a higher tendency toward paravalvular regurgitation rates but lower acute kidney injury rate, except for the low risk group.
Patient or healthcare consumer involvement: None
Attached Figure: Forest plots of all-cause mortality of RCTs; (A) short-term all-cause mortality (B) mid-term all-cause mortality (C) long-term all-cause mortality