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Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk

BACKGROUND: The aim of this meta-analysis was to compare the impact of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in patients with severe aortic valve stenosis (AS) at low surgical risk. METHODS: All randomized controlled trials (RCTs) and observation...

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Autores principales: Acconcia, Maria Cristina, Perrone, Marco Alfonso, Sergi, Domenico, Di Luozzo, Marco, Marchei, Massimo, De Vico, Pasquale, Scavalli, Antonio Sili, Pannarale, Giuseppe, Chiocchi, Marcello, Gaudio, Carlo, Romeo, Francesco, Caretta, Quintilio, Barillà, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Via Medica 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508068/
https://www.ncbi.nlm.nih.gov/pubmed/34622437
http://dx.doi.org/10.5603/CJ.a2021.0114
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author Acconcia, Maria Cristina
Perrone, Marco Alfonso
Sergi, Domenico
Di Luozzo, Marco
Marchei, Massimo
De Vico, Pasquale
Scavalli, Antonio Sili
Pannarale, Giuseppe
Chiocchi, Marcello
Gaudio, Carlo
Romeo, Francesco
Caretta, Quintilio
Barillà, Francesco
author_facet Acconcia, Maria Cristina
Perrone, Marco Alfonso
Sergi, Domenico
Di Luozzo, Marco
Marchei, Massimo
De Vico, Pasquale
Scavalli, Antonio Sili
Pannarale, Giuseppe
Chiocchi, Marcello
Gaudio, Carlo
Romeo, Francesco
Caretta, Quintilio
Barillà, Francesco
author_sort Acconcia, Maria Cristina
collection PubMed
description BACKGROUND: The aim of this meta-analysis was to compare the impact of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in patients with severe aortic valve stenosis (AS) at low surgical risk. METHODS: All randomized controlled trials (RCTs) and observational studies (Obs) published from January 2014 until March 31(st), 2020 were retrieved through the PubMed computerized database and at the site https://www.clinicaltrials.com. The relative risk (RR) with the 95% confidence interval (CI) was used to evaluate the effect of the intervention under comparison. The primary endpoints were all-cause 30-day mortality and 1-year mortality. The 30-day safety endpoints were: stroke, acute kidney injury stage 2 or 3, major bleeding, moderate/severe paravalvular leak, need for new permanent pacemaker (PM) implantation. RESULTS: After detailed review 9 studies, related to 4 RCTs and 5 Obs, were selected. The overall analysis of RCTs plus Obs showed a significantly lower 30-day mortality for TAVI (RR = 0.55; 95% CI 0.45–0.68, p < 0.00001; I(2) = 0%). However, an increased risk of new PM implantation (RR = 2.87; 95% CI 2.01–3.67, p < 0.00001, I(2) = 0%) and of paravalvular leak (RR = 7.28; 95% CI 3.83–13.81, p < 0.00001, I(2) = 0%) was observed in TAVI compared to SAVR. On the contrary, a lower incidence of major bleeding (RR = 0.38; 95% CI 0.27–0.54, p < 0.00001, I(2) = 0%) and of acute kidney injury was observed (RR = 0.33; 95% CI 0.19–0.56, p < 0.0001, I(2) = 0%) in TAVI. CONCLUSIONS: TAVI and SVAR in the treatment of AS in the patients at low surgical risk are not superimposable. In particular, if 30-day and 1-year mortality, major bleeding and acute kidney injury were significantly lower for TAVI, the need of new PM implantation and paravalvular leak were significantly lower in SAVR. Consequently, we suggest the need of more trials to evaluate the effectiveness of TAVI as routine therapeutic procedure in the treatment of patients with low surgical risk AS.
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spelling pubmed-105080682023-09-20 Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk Acconcia, Maria Cristina Perrone, Marco Alfonso Sergi, Domenico Di Luozzo, Marco Marchei, Massimo De Vico, Pasquale Scavalli, Antonio Sili Pannarale, Giuseppe Chiocchi, Marcello Gaudio, Carlo Romeo, Francesco Caretta, Quintilio Barillà, Francesco Cardiol J Clinical Cardiology BACKGROUND: The aim of this meta-analysis was to compare the impact of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) in patients with severe aortic valve stenosis (AS) at low surgical risk. METHODS: All randomized controlled trials (RCTs) and observational studies (Obs) published from January 2014 until March 31(st), 2020 were retrieved through the PubMed computerized database and at the site https://www.clinicaltrials.com. The relative risk (RR) with the 95% confidence interval (CI) was used to evaluate the effect of the intervention under comparison. The primary endpoints were all-cause 30-day mortality and 1-year mortality. The 30-day safety endpoints were: stroke, acute kidney injury stage 2 or 3, major bleeding, moderate/severe paravalvular leak, need for new permanent pacemaker (PM) implantation. RESULTS: After detailed review 9 studies, related to 4 RCTs and 5 Obs, were selected. The overall analysis of RCTs plus Obs showed a significantly lower 30-day mortality for TAVI (RR = 0.55; 95% CI 0.45–0.68, p < 0.00001; I(2) = 0%). However, an increased risk of new PM implantation (RR = 2.87; 95% CI 2.01–3.67, p < 0.00001, I(2) = 0%) and of paravalvular leak (RR = 7.28; 95% CI 3.83–13.81, p < 0.00001, I(2) = 0%) was observed in TAVI compared to SAVR. On the contrary, a lower incidence of major bleeding (RR = 0.38; 95% CI 0.27–0.54, p < 0.00001, I(2) = 0%) and of acute kidney injury was observed (RR = 0.33; 95% CI 0.19–0.56, p < 0.0001, I(2) = 0%) in TAVI. CONCLUSIONS: TAVI and SVAR in the treatment of AS in the patients at low surgical risk are not superimposable. In particular, if 30-day and 1-year mortality, major bleeding and acute kidney injury were significantly lower for TAVI, the need of new PM implantation and paravalvular leak were significantly lower in SAVR. Consequently, we suggest the need of more trials to evaluate the effectiveness of TAVI as routine therapeutic procedure in the treatment of patients with low surgical risk AS. Via Medica 2023-08-31 /pmc/articles/PMC10508068/ /pubmed/34622437 http://dx.doi.org/10.5603/CJ.a2021.0114 Text en Copyright © 2023 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
spellingShingle Clinical Cardiology
Acconcia, Maria Cristina
Perrone, Marco Alfonso
Sergi, Domenico
Di Luozzo, Marco
Marchei, Massimo
De Vico, Pasquale
Scavalli, Antonio Sili
Pannarale, Giuseppe
Chiocchi, Marcello
Gaudio, Carlo
Romeo, Francesco
Caretta, Quintilio
Barillà, Francesco
Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title_full Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title_fullStr Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title_full_unstemmed Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title_short Transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
title_sort transcatheter aortic valve implantation results are not superimposable to surgery in patients with aortic stenosis at low surgical risk
topic Clinical Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10508068/
https://www.ncbi.nlm.nih.gov/pubmed/34622437
http://dx.doi.org/10.5603/CJ.a2021.0114
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