Early and intermediate survival after transcatheter aortic valve implantation: systematic review and meta-analysis of 14 studies.

BACKGROUND

Transcatheter aortic valve implants (TAVIs) is indicated as an alternative to surgical valve replacement for patients unfit for surgery. No systematic review has studied survival after 2 years and limited information is available on between-study heterogeneity.

OBJECTIVES

A systematic review and meta-analysis on intermediate survival after TAVI.

DATA SOURCES

PubMed, EMBASE, Scopus and references of selected articles.

STUDY ELIGIBILITY CRITERIA

Clinical studies evaluating TAVI, published between 2010 and 2012, reporting survival at 2 or more years.

PARTICIPANTS

About 3500 patients from 14 studies.

STUDY APPRAISAL AND SYNTHESIS METHODS

Proportion meta-analysis with 95% CI and heterogeneity assessment (I(2) and Cochran's Q). Meta-regression analysis was performed as well.

RESULTS

Pooled immediate postoperative death rate was 7.8% (95% CI 6.2% to 9.8%, I(2)=40.8%; Cochran's Q=97.7 with 92.9 df, p<0.0001) and stroke rate was 3.8% (95% CI 2.8% to 5.0%, I(2)=34.3%; Cochran's Q=96.5 with 92.9 df, p<0.0001). Pooled death rates at 1, 2 and 3 years were 23.2%, 31.0% and 38.6%, respectively. Among studies reporting on concomitant percutaneous coronary intervention, pooled death rates at 30 days, 1 year and 2 years were 6.3%, 17.8% and 25.8%, respectively.

LIMITATIONS

Although our analysis examined a total of about 3500 patients, only a minority of these were actually followed up after 2 years.

CONCLUSIONS

Pooled survival rates after TAVI (at 2 years: 69.0%; at 3 years: 61.4%) can be considered excellent, particularly in the light of the high-risk profile of this patient population. IMPLICATIONS OF KEY FINDINGS: The favourable intermediate outcome in patients subjected to TAVI seems to justify its use in patients unfit for surgery. Such pooled results indicate that TAVI is a valid alternative to surgical valve replacement, but lack of data on late durability after TAVI prevents its use in low-risk patients with long expectancy of life.