Moradi Iman, Mustafa Muhammad Saqlain, Sardar Sheikh Jannat, Shojai Rahnama Behrooz, Fredericks Matthew, Kumar Yennam Anil, Arain Mustafa, Saha Utsow, Richard Ma Andrew, Nagendran Adithya, Bin Omer Moosa, Armaghan Muhammad, Jaimes Diana Carolina Cortés, Avinash Bojanki Nagavenkata Lova Surya Vamsi, Shafique Muhammad Ashir
Department of Medicine, Saint George's University, Grenada 0000, Grenada.
Department of Medicine, Jinnah Sindh Medical University, Karachi 75510, Sindh, Pakistan.
World J Cardiol. 2025 Apr 26;17(4):104168. doi: 10.4330/wjc.v17.i4.104168.
The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR), offering a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, the comparative safety and efficacy of these interventions remain subjects of ongoing investigation.
To compare the clinical outcomes and safety of TAVR SAVR in patients with severe symptomatic aortic stenosis.
A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) comparing TAVR and SAVR were identified from databases including PubMed, Scopus, and Web of Science up to May 31, 2024. Data were extracted on clinical outcomes, including mortality, procedural complications, and post-procedure adverse events. Risk ratios (RRs) with 95%CIs were calculated using a random-effects model.
A total of 10 RCTs were included. TAVR demonstrated a significantly lower risk of acute kidney injury (RR: 0.33; 95%CI: 0.25-0.44), major bleeding (RR: 0.37; 95%CI: 0.30-0.46), and new-onset atrial fibrillation (RR: 0.44; 95%CI: 0.34-0.57) compared to SAVR. However, TAVR was associated with higher risks of new permanent pacemaker implantation (RR: 3.49; 95%CI: 2.77-4.39), major vascular complications (RR: 2.47; 95%CI: 1.91-3.21), and paravalvular leaks (RR: 4.15; 95%CI: 3.14-5.48). Mortality at 30 days was comparable (RR: 0.95; 95%CI: 0.78-1.15), but long-term mortality was slightly higher with TAVR in some analyses (RR: 1.23; 95%CI: 1.01-1.49). Rates of stroke (RR: 0.97; 95%CI: 0.81-1.17) and myocardial infarction (RR: 0.91; 95%CI: 0.67-1.24) were similar between the groups.
TAVR offers a less invasive option with significant benefits in reducing acute kidney injury, major bleeding, and new-onset atrial fibrillation, making it particularly advantageous for high-risk surgical candidates. However, higher risks of permanent pacemaker implantation, vascular complications, and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
经导管主动脉瓣置换术（TAVR）彻底改变了严重症状性主动脉瓣狭窄的治疗方式，为外科主动脉瓣置换术（SAVR）提供了一种微创替代方案。然而，这些干预措施的相对安全性和有效性仍是正在进行研究的课题。
比较TAVR与SAVR治疗严重症状性主动脉瓣狭窄患者的临床结局和安全性。
根据PRISMA指南进行系统评价和荟萃分析。从包括PubMed、Scopus和Web of Science在内的数据库中检索截至2024年5月31日比较TAVR和SAVR的随机对照试验（RCT）。提取有关临床结局的数据，包括死亡率、手术并发症和术后不良事件。使用随机效应模型计算95%置信区间（CI）的风险比（RR）。
共纳入10项RCT。与SAVR相比，TAVR显示急性肾损伤风险显著降低（RR：0.33；95%CI：0.25 - 0.44）、大出血风险（RR：0.37；95%CI：0.30 - 0.46）和新发房颤风险（RR：0.44；95%CI：0.34 - 0.57）。然而，TAVR与新的永久性起搏器植入风险较高（RR：3.49；95%CI：2.77 - 4.39）、主要血管并发症风险（RR：2.47；95%CI：1.91 - 3.21）和瓣周漏风险（RR：4.15；95%CI：3.14 - 5.48）相关。术后30天死亡率相当（RR：0.95；95%CI：0.78 - 1.15），但在一些分析中TAVR的长期死亡率略高（RR：1.23；95%CI：1.01 - 1.49）。两组之间的卒中发生率（RR：0.97；95%CI：0.81 - 1.17）和心肌梗死发生率（RR：0.91；95%CI：0.67 - 1.24）相似。
TAVR提供了一种侵入性较小的选择，在降低急性肾损伤、大出血和新发房颤方面有显著益处，使其对高危手术候选者特别有利。然而，永久性起搏器植入、血管并发症和瓣周漏的较高风险凸显了个体化患者选择和共同决策以优化结局的必要性。
