Transcatheter aortic valve replacement versus surgery for symptomatic severe aortic stenosis: A reconstructed individual patient data meta‐analysis. Issue 1 (30th September 2019)

• Record Type: Journal Article
• Authors: Dowling, Cameron; Kondapally Seshasai, Sreenivasa Rao; Firoozi, Sami; Brecker, Stephen J.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 96:Issue 1(2020)
• Page Start: 158
• Page End: 166
• Publication Date: 2019-09-30
• Subjects: aortic valve stenosis -- transcatheter aortic valve replacement -- heart valve prosthesis implantation -- meta‐analysis; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28504
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: We wished to undertake a reconstructed individual patient data meta‐analysis of randomized clinical trials comparing transcatheter aortic valve replacement (TAVR) and surgery for patients with severe symptomatic aortic stenosis. Background: TAVR and surgery are both well‐established methods for treating patients with symptomatic severe aortic stenosis who are at low, intermediate, and high risk for surgery. Methods: Data were identified by searches of Medline, Embase, CENTRAL and ClinicalTrials.gov for all randomized clinical trials, which compared TAVR and surgery that had published at least 1 year of follow‐up. Individual patient data were reconstructed from Kaplan–Meier curves. Results: A total of 7, 770 patients from seven randomized clinical trials were included in this meta‐analysis. At 1 year, TAVR was associated with a lower risk of death from any cause (hazard ratio [HR], 0.85, 95% confidence interval [CI], 0.73–0.98; p = .03), disabling stroke (HR, 0.71; 95% CI, 0.54–0.93; p = .01) and the composite end point of death or disabling stroke (HR, 0.79; 95% CI, 0.67–0.92; p = .002). Significant interactions were found for access suitability, with TAVR associated with a lower risk of these end points in patients suitable for transfemoral access. TAVR was associated with a lower risk of periprocedural events, whereas the risk of late events was similar between TAVR and surgery. Conclusions: At 1 year, TAVR was associated with a lower risk of death, disabling stroke and the composite end point, when compared with surgery. These associations were strongest within the subgroup of patients in whom transfemoral access was feasible.