Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Cardiovascular disease, Allegheny General Hospital, Pittsburgh, PA, USA.
J Cardiothorac Surg. 2021 Oct 20;16(1):312. doi: 10.1186/s13019-021-01689-3.
The treatment of symptomatic severe aortic stenosis (AS) has rapidly evolved over the past decade, in both transcatheter (TAVR) and surgical aortic valve replacement (SAVR), resulting in reported improved clinical outcomes. Operator experience and technical improvements have improved outcomes especially for patients undergoing TAVR. We sought to determine and compare 1-year outcomes using a contemporary meta-analysis.
We searched the Medline (MESH), Cochrane and Google scholar databases using keywords "AS", "atrial fibrillation" (AFib) and "stroke". We performed a meta-analysis to compare TAVR with SAVR populations for post-procedural stroke, all-cause and cardiovascular mortality at 1-year.
A total of 23 studies met criteria for analysis with total population of 66,857 patients, of which 61,913 had TAVR and 4944 had SAVR. Temporal trends demonstrated overall improvement in outcome for both, TAVR and SAVR groups through the decade. Outcomes, in terms of stroke (3.1% vs. 5%), all-cause (12.4% vs. 10.3%) and cardiovascular mortality (7.2% vs. 6.2%) were similar at 1-year, in TAVR versus SAVR, respectively.
Despite overall gradual improvement in both TAVR and SAVR outcomes over the decade, there is a statistical overlap in confidence intervals for all-cause, cardiovascular mortality and postprocedural stroke at 1-year. While 23 individual studies demonstrate considerable advantages of each technique in certain cohorts, integrating over 65,000 pts with our stratified surgical analysis suggests that TAVR is comparable to SAVR for low and intermediate risk population while superior to SAVR only in the highest-risk population for short and intermediate term outcomes. This has substantial socio-economic implications as we contemplate expanding our TAVR indications to low/intermediate risk populations.
过去十年间，经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）在治疗有症状的重度主动脉瓣狭窄（AS）方面迅速发展，由此带来的临床结果得到改善。术者经验和技术的改进提高了治疗效果，尤其在 TAVR 治疗患者中。我们试图通过当代荟萃分析来确定和比较 1 年的结果。
我们使用关键词“AS”、“房颤（AFib）”和“中风”，在 Medline（MESH）、Cochrane 和 Google Scholar 数据库中进行搜索。我们进行荟萃分析比较了 TAVR 与 SAVR 人群术后中风、1 年全因和心血管死亡率的差异。
共有 23 项研究符合分析标准，总人群为 66857 例患者，其中 61913 例接受了 TAVR，4944 例接受了 SAVR。通过十年间的时间趋势，TAVR 和 SAVR 两组的结果都显示出整体的改善。TAVR 与 SAVR 相比，1 年时的中风（3.1% vs. 5%）、全因（12.4% vs. 10.3%）和心血管死亡率（7.2% vs. 6.2%）结果相似。
尽管过去十年间 TAVR 和 SAVR 的结果都逐渐改善，但 1 年时全因、心血管死亡率和术后中风的置信区间存在统计学重叠。虽然 23 项单独研究在某些队列中显示出每种技术的显著优势，但对超过 65000 例患者进行分层手术分析表明，TAVR 对于低危和中危人群与 SAVR 相当，而对于短期和中期结果高危人群则优于 SAVR。这对我们考虑将 TAVR 适应证扩展到低危/中危人群具有重要的社会经济意义。
