Transcatheter <b><i>versus</i></b> surgical aortic valve replacement in patients with severe aortic stenosis at intermediate-low risk: a Meta-analysis _West China Medical Journal

Authors：

HE Jialing , LEI Wenhua , LIAO Yanbiao , LI Yijian ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; Aortic stenosis; Intermediate-low risk; Stroke; Meta-analysis

DOI：

10.7507/1002-0179.201711138

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ObjectiveTo systematically review the efficiency and safety of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis at intermediate-low risk compared with surgical aortic valve replacement (SAVR).MethodsTwo researchers searched literatures independently in databases including PubMed, Embase, Scopus, Cochrane Library, China Biology Medicine disc, China National Knowledge Internet, VIP database for studies published from January 2012 to October 2017, then screened for propriate studies, collected information from different follow-up period all on the principle of Cocharan handbook. At last statistal analysis was performed in RevMan 5.3 to calculate relative risk (RR) and its 95% confidence interval (CI).ResultsThirteen studies were enrolled in this Meta-analysis with 10 753 patients, including 5 263 cases in TAVR group and 5 490 cases in SAVR group. Meta-analysis showed that there were no statistically significant differences in all-cause mortality between TAVR group and SAVR group in 30 days, 1 year or 2 years after operation [RR=0.96, 95%CI (0.75, 1.24), P=0.78; RR=0.84, 95%CI (0.68, 1.03), P=0.09; RR=0.97, 95%CI (0.84, 1.14), P=0.75]; while stroke more preferred SAVR no matter 30 days or 1 year [RR=0.64, 95%CI (0.51, 0.80), P<0.000 1;RR=0.76, 95%CI (0.63, 0.92), P=0.004].ConclusionThere is no significant difference in all-cause mortality of intermediate-low risk patients undergoing TAVR and SAVR, but TAVR perfoms better in terms of srtoke.

Citation： HE Jialing, LEI Wenhua, LIAO Yanbiao, LI Yijian, CHEN Mao. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at intermediate-low risk: a Meta-analysis . West China Medical Journal, 2018, 33(2): 201-209. doi: 10.7507/1002-0179.201711138 Copy

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2.	Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2485-2491.
3.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
4.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). G Ital Cardiol (Rome), 2013, 14(3): 167-214.
5.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
6.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
8.	Nielsen HH, Klaaborg KE, Nissen H, et al. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. EuroIntervention, 2012, 8(3): 383-389.
9.	Thyregod HG, Steinbruchel DA, Nissen H, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis 1-year results from the All-Comers NOTION randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
10.	Søndergaard L, Steinbrüchel DA, Ihlemann N, et al. Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers Nordic Aortic Valve Intervention Randomized Clinical Trial. Circ Cardiovasc Interv, 2016, 9(6): e003665.
11.	Arnold SV, Reynolds MR, Wang KA, et al. Health status after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis at increased surgical risk results from the CoreValve US pivotal trial. JACC Cardiovasc Interv, 2015, 8(9): 1207-1217.
12.	Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
13.	Frerker C, Bestehorn K, Schlueter MA, et al. In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany. Clin Res Cardiol, 2017, 106(8): 610-617.
14.	Fraccaro C, Tarantini G, Rosato S, et al. Early and midterm outcome of propensity-matched intermediate-risk patients aged ≥80 years with aortic stenosis undergoing surgical or transcatheter aortic valve replacement (from the Italian multicenter OBSERVANT Study). Am J cardiol, 2016, 117(9): 1494-1501.
15.	Schymik G, Heimeshoff M, Bramlage PA, et al. A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk. Catheter Cardiovasc Interv, 2015, 86(4): 738-744.
16.	Piazza N, Kalesan B, van Mieghem N, et al. A 3-Center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JACC Cardiovasc Interv, 2013, 6(5): 443-451.
17.	Latib A, Maisano F, Bertoldi L, et al. Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score-matched case-control study. Am Heart J, 2012, 164(6): 910-917.
18.	Castrodeza J, Amat-Santos IJ, Blanco MA, et al. Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: a hint of real-world. Cardiol J, 2016, 23(5): 541-551.
19.	Schymik G, Schroefel H, Heimeshoff M, et al. How to adapt the implantation technique for the new SAPIEN 3 transcatheter heart valve design. J Interv Cardiol, 2015, 28(1): 82-89.
20.	Siemieniuk RA, Agoritsas T, Manja V, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. BMJ, 2016, 354: i5130.
21.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
22.	Gargiulo G, Sannino A, Capodanno D, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement a systematic review and meta-analysis. Ann Intern Med, 2016, 165(5): 334-344.
23.	Siontis GC, Praz F, Pilgrim T, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J, 2016, 37(47): 3503-3512.
24.	Arora S, Misenheimer JA, Jones W, et al. Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis. Cardiovasc Diagn Ther, 2016, 6(3): 241-249.
25.	Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and Consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
26.	Cao C, Ang SC, Indraratna P, et al. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg, 2013, 2(1): 10-23.
27.	Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation, 2012, 126(19): 2335-2344.
28.	Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
29.	Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
30.	Willson AB, Webb JG, Labounty TM, et al. 3-Dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement a multicenter retrospective analysis. J Am Coll Cardiol, 2012, 59(14): 1287-1294.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2. Kapadia SR, Leon MB, Makkar RR, et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2485-2491.
3. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
4. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). G Ital Cardiol (Rome), 2013, 14(3): 167-214.
5. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
6. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
7. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
8. Nielsen HH, Klaaborg KE, Nissen H, et al. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis: the STACCATO trial. EuroIntervention, 2012, 8(3): 383-389.
9. Thyregod HG, Steinbruchel DA, Nissen H, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis 1-year results from the All-Comers NOTION randomized clinical trial. J Am Coll Cardiol, 2015, 65(20): 2184-2194.
10. Søndergaard L, Steinbrüchel DA, Ihlemann N, et al. Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers Nordic Aortic Valve Intervention Randomized Clinical Trial. Circ Cardiovasc Interv, 2016, 9(6): e003665.
11. Arnold SV, Reynolds MR, Wang KA, et al. Health status after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis at increased surgical risk results from the CoreValve US pivotal trial. JACC Cardiovasc Interv, 2015, 8(9): 1207-1217.
12. Thourani VH, Kodali S, Makkar RR, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet, 2016, 387(134): 2218-2225.
13. Frerker C, Bestehorn K, Schlueter MA, et al. In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany. Clin Res Cardiol, 2017, 106(8): 610-617.
14. Fraccaro C, Tarantini G, Rosato S, et al. Early and midterm outcome of propensity-matched intermediate-risk patients aged ≥80 years with aortic stenosis undergoing surgical or transcatheter aortic valve replacement (from the Italian multicenter OBSERVANT Study). Am J cardiol, 2016, 117(9): 1494-1501.
15. Schymik G, Heimeshoff M, Bramlage PA, et al. A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk. Catheter Cardiovasc Interv, 2015, 86(4): 738-744.
16. Piazza N, Kalesan B, van Mieghem N, et al. A 3-Center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JACC Cardiovasc Interv, 2013, 6(5): 443-451.
17. Latib A, Maisano F, Bertoldi L, et al. Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score-matched case-control study. Am Heart J, 2012, 164(6): 910-917.
18. Castrodeza J, Amat-Santos IJ, Blanco MA, et al. Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: a hint of real-world. Cardiol J, 2016, 23(5): 541-551.
19. Schymik G, Schroefel H, Heimeshoff M, et al. How to adapt the implantation technique for the new SAPIEN 3 transcatheter heart valve design. J Interv Cardiol, 2015, 28(1): 82-89.
20. Siemieniuk RA, Agoritsas T, Manja V, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. BMJ, 2016, 354: i5130.
21. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
22. Gargiulo G, Sannino A, Capodanno D, et al. Transcatheter aortic valve implantation versus surgical aortic valve replacement a systematic review and meta-analysis. Ann Intern Med, 2016, 165(5): 334-344.
23. Siontis GC, Praz F, Pilgrim T, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J, 2016, 37(47): 3503-3512.
24. Arora S, Misenheimer JA, Jones W, et al. Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis. Cardiovasc Diagn Ther, 2016, 6(3): 241-249.
25. Houthuizen P, van der Boon RM, Urena M, et al. Occurrence, fate and Consequences of ventricular conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention, 2014, 9(10): 1142-1150.
26. Cao C, Ang SC, Indraratna P, et al. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg, 2013, 2(1): 10-23.
27. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation, 2012, 126(19): 2335-2344.
28. Rosato S, Santini F, Barbanti M, et al. Transcatheter aortic valve implantation compared with surgical aortic valve replacement in low-risk patients. Circ Cardiovasc Interv, 2016, 9(5): e003326.
29. Kodali SK, Williams MR, Smith CR, et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med, 2012, 366(18): 1686-1695.
30. Willson AB, Webb JG, Labounty TM, et al. 3-Dimensional aortic annular assessment by multidetector computed tomography predicts moderate or severe paravalvular regurgitation after transcatheter aortic valve replacement a multicenter retrospective analysis. J Am Coll Cardiol, 2012, 59(14): 1287-1294.

West China Medical Journal

Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at intermediate-low risk: a Meta-analysis

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