Efficacy and safety of TAVR versus SAVR in patients with small aortic annuli: A systematic review and meta-analysis
Recommended Citation
Ayyad M, Jabri A, Khalefa BB, Al-Abdouh A, Madanat L, Albandak M, Alhuneafat L, Sukhon F, Shahrori Z, Mourid MR, Mhanna M, Giustino G, Wang DD, Hanson ID, Abbas AE, AlQarqaz M, and Villablanca P. Efficacy and safety of TAVR versus SAVR in patients with small aortic annuli: A systematic review and meta-analysis. Int J Cardiol 2024; 132243.
Document Type
Article
Publication Date
9-15-2024
Publication Title
International journal of cardiology
Abstract
INTRODUCTION: Patients with a small aortic annulus (SAA) undergoing aortic valve replacement are at increased risk of patient-prosthesis mismatch (PPM), which adversely affects outcomes. Transcatheter aortic valve replacement (TAVR) has shown promise in mitigating PPM compared to surgical aortic valve replacement (SAVR).
METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines to compare clinical outcomes, mortality, and PPM between SAA patients undergoing TAVR and SAVR. Eligible studies were identified through comprehensive literature searches and assessed for quality and relevance.
RESULTS: Nine studies with a total of 2476 patients were included. There was no significant difference in 30-day Mortality between TAVR vs SAVR groups (OR = 0.65, 95% CI [ 0.09-4.61], P = 0.22). There was no difference between both groups regarding myocardial infarction at 30 days (OR = 0.63, 95% CI [0.1-3.89], P = 0.62). TAVR was associated with a significantly lower 30-day major bleeding and 2-year major bleeding, Pooled studies were homogeneous (OR = 0.44, 95% CI [0.31-0.64], P < 0.01, I2 = 0, P = 0.89), (OR = 0.4 ,95% CI [0.21-0.77], P = 0.03, I2 = 0%, P = 0.62) respectively. TAVR was associated with a lower rate of moderate PPM (OR = 0.6, 95% CI [ 0.44-0.84], p value = 0.01, i2 = 0%, p value = 0.44). The overall effect estimate did not favor any of the two groups regarding short-term Mild AR (OR = 5.44, 95% CI [1.02-28.91], P = 0.05) and Moderate/severe AR (OR = 4.08, 95% CI [ 0.79-21.02], P = 0.08, I2 = 0%, P = 0.59).
CONCLUSION: Our findings suggest that both TAVR and SAVR are viable options for treating AS in patients with a small aortic annulus. TAVR offers advantages in reducing PPM and major bleeding, while SAVR performs better in terms of pacemaker implantation. Future studies should focus on comparing newer generation TAVR techniques and devices with SAVR. Consideration of patient characteristics is crucial in selecting the optimal treatment approach for AS.
Medical Subject Headings
Humans; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Treatment Outcome; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis
PubMed ID
38851542
ePublication
ePub ahead of print
Volume
411
First Page
132243
Last Page
132243
