Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) vs. surgical aortic valve replacement as treatment for severe aortic valve stenosis: a meta-analysis
Background: For severe aortic stenosis, surgical aortic valve replacement (SAVR) remains the procedure of choice in relieving outflow obstruction. However, transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality. Despite numerous research, its role in patients who are potential surgical candidates remains controversial.
Objective: To determine the effectiveness of TAVI over SAVR in reducing all-cause mortality among patients diagnosed with severe aortic stenosis.
Methods: Four randomised controlled trials were included in this meta-analysis after a thorough search of four electronic databases, free search, and reference review. The primary end-point is all- cause mortality. Several periprocedural outcomes were also assessed.
Results: A total of four articles and 1748 patients were included in this meta-analysis. Results indicated no significant difference between TAVI versus SAVR in terms of all-cause mortality. There is a trend towards reduced incidence of stroke or transient ischemic attacks and major vascular complications in the SAVR group. On the contrary, there is reduced incidence of myocardial infarction and major bleeding in TAVI compared to SAVR. There is no significant difference in terms of death from cardiovascular causes, repeat hospitalizations, development of renal failure, endocarditis, cardiac arrhythmias requiring pacemaker insertion, and mean aortic valve orifice area between TAVI and SAVR. Conclusion: The available data on TAVI versus SAVR indicate that major outcomes such as mortality are comparable between both procedures. While there is increased incidences of stroke and major vascular complications in the TAVI arm, there is higher risk of bleeding and myocardial infarction in the SAVR arm. Until present, data on the effectiveness of TAVI is limited due to the lack of long-term studies. Thus, for patients who are suitable surgical candidates, SAVR remains to be the procedure of choice until long-term data will be available to favour TAVI.