Ajmal Zeeshan, Rehman Zaeem Ur, Ishtiaq Ayesha, Iftikhar Hamdah, Khokhar Mohammad M, Khan Bilal, Asad Ali, Nasir Hannan, Athar Syed Muhammad, Hassan Ahmad, Naveed Hira
Anesthesiology, Gulab Devi Hospital, Lahore, PAK.
Medicine, Islam Medical College, Sialkot, PAK.
Cureus. 2024 Sep 26;16(9):e70268. doi: 10.7759/cureus.70268. eCollection 2024 Sep.
Aortic stenosis (AS) is a prevalent condition among the elderly, characterized by the narrowing of the aortic valve, which, if untreated, can lead to heart failure and decreased quality of life in terms of reduced activity and high mortality in one to two years. Surgical aortic valve replacement (SAVR) has long been the standard treatment for AS. However, it poses significant risks, particularly in older patients with comorbidities. In recent years, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative and is increasingly used in low- and moderate-risk patients. This review seeks to assess the comparative outcomes of TAVR and SAVR in patients with moderate-risk AS. A systematic review was conducted in accordance with PRISMA guidelines, focusing on randomized controlled trials (RCTs) that compared TAVR and SAVR in this patient population. Also, the review included three major RCTs: PARTNER 2, UK TAVI, and DEDICATE. We analyzed the key outcomes of TAVR and SAVR, such as mortality, reintervention rates, complications (such as myocardial infarction, prosthetic valve endocarditis, and pacemaker implantation), and reintervention rates, to evaluate the relative efficacy and safety of TAVR and SAVR. The analysis included data from 4,359 patients across the three trials. TAVR demonstrated a lower all-cause mortality in two of the three trials, with an overall trend favoring TAVR in terms of survival. However, TAVR was associated with a higher incidence of prosthetic valve endocarditis, a greater need for pacemaker implantation, and more frequent reinterventions compared to SAVR. In conclusion, the findings suggest that TAVR may be a better option for moderate-risk AS patients, offering higher survival rates and a less invasive recovery process. While TAVR carries increased risks of endocarditis and pacemaker dependency, its overall benefits, particularly in terms of lower mortality and improved patient outcomes, make it a preferable option over SAVR for many patients. However, acknowledging potential limitations such as variations in trial design and differences in patient populations would indeed provide a more comprehensive perspective. Further research and long-term follow-up are essential to confirm these findings and refine patient selection criteria.
主动脉瓣狭窄（AS）在老年人中是一种常见病症，其特征是主动脉瓣狭窄，如果不进行治疗，可能导致心力衰竭，并在活动减少以及一到两年内高死亡率方面导致生活质量下降。外科主动脉瓣置换术（SAVR）长期以来一直是AS的标准治疗方法。然而，它存在重大风险，特别是在患有合并症的老年患者中。近年来，经导管主动脉瓣置换术（TAVR）已成为一种侵入性较小的替代方法，并越来越多地用于低风险和中度风险患者。本综述旨在评估TAVR和SAVR在中度风险AS患者中的比较结果。根据PRISMA指南进行了一项系统综述，重点关注比较该患者群体中TAVR和SAVR的随机对照试验（RCT）。此外，该综述包括三项主要的RCT：PARTNER 2、英国TAVI和DEDICATE。我们分析了TAVR和SAVR的关键结果，如死亡率、再次干预率、并发症（如心肌梗死、人工瓣膜心内膜炎和起搏器植入）以及再次干预率，以评估TAVR和SAVR的相对疗效和安全性。分析包括来自三项试验的4359名患者的数据。在三项试验中的两项中，TAVR显示出较低的全因死亡率，总体上在生存方面有利于TAVR。然而，与SAVR相比，TAVR与人工瓣膜心内膜炎的发生率较高、起搏器植入的需求更大以及更频繁的再次干预相关。总之，研究结果表明，TAVR可能是中度风险AS患者的更好选择，具有更高的生存率和侵入性较小的恢复过程。虽然TAVR增加了心内膜炎和起搏器依赖的风险，但其总体益处，特别是在较低死亡率和改善患者结果方面，使其成为许多患者优于SAVR的首选。然而，认识到潜在的局限性，如试验设计的差异和患者群体的差异，确实会提供更全面的观点。进一步的研究和长期随访对于证实这些发现并完善患者选择标准至关重要。
