Transcatheter aortic valve replacement (TAVR) has
recently been approved for use in patients who are at
intermediate and low surgical risk. Moreover, recent years
have witnessed a renewed interest in minimally invasive
aortic valve replacement (miAVR). The present meta-analysis
compared the outcomes of TAVR and miAVR in
the management of aortic stenosis (AS). We conducted
an electronic search across six databases from 2002
(TAVR inception) to December 2019. Data from relevant
studies regarding the clinical and length of hospitalisation
outcomes were extracted and analysed using R software.
We identified a total of 11 cohort studies, of which
seven were matched/propensity matched. Our analysis
demonstrated higher rates of midterm mortality (≥1 year)
with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but
no significant differences with respect to 1 month mortality
(RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95%
CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to
3.75) rates. Patients undergoing TAVR were more likely
to experience paravalvular leakage (RR: 14.89, 95% CI:
6.89 to 32.16), yet less likely to suffer acute kidney injury
(RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR.
The duration of hospitalisation was significantly longer in
the miAVR group (mean difference: 1.92 (0.61 to 3.24)).
Grading of Recommendations Assessment, Development
and Evaluation assessment revealed ≤moderate quality
of evidence in all outcomes. TAVR was associated with
lower acute kidney injury rate and shorter length of
hospitalisation, yet higher risks of midterm mortality and
paravalvular leakage. Given the increasing adoption of
both techniques, there is an urgent need for head-to-
head
randomised trials with adequate follow-up
periods. |
