TCT-144 Comparative Safety and Effectiveness of Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in Patients With a Small Aortic Annulus: A Systematic Review and Meta-Analysis
Recommended Citation
Madanat L, Ayyad M, Al-Abdouh A, Mhanna M, Alhuneafat L, Obeidat L, Alqarqaz M, Hanson I, Abbas A, Frisoli T, Villablanca P. TCT-144 Comparative Safety and Effectiveness of Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement in Patients With a Small Aortic Annulus: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2024; 84(18):B365-B366.
Document Type
Conference Proceeding
Publication Date
10-29-2024
Publication Title
J Am Coll Cardiol
Abstract
Background: 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 with 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. Results: Nine studies were included with a total of 2,476 patients (1,259 patients in the TAVR group and 1,217 in the SAVR group). TAVR demonstrated similar 30-day (OR: 0.65; 95% CI: 0.09-4.61; P = 0.22) and 2-year mortality (OR: 0.82; 95% CI: 0.53-1.27: P = 0.24), myocardial infarction (OR: 0.73; 95% CI: 0.1-5.18; P = 0.56), and stroke rates (OR: 1.1; 95% CI: 0.23-5.2; P = 0.86) compared with SAVR. However, TAVR showed significant advantages in reducing severe PPM (OR: 0.53; 95% CI: 0.39-0.72; P < 0.0001) and major bleeding at both 30 days (OR: 0.44; 95% CI: 0.31-0.64; P < 0.01) and 2 years (OR: 0.4; 95% CI: 0.21-0.77; P = 0.03) post procedure. Conversely, TAVR had worse outcomes in 30-day permanent pacemaker implantation rates (OR: 2.76; 95% CI: 1.13-6.75; P =0.04) (Figure 1). Conclusion: Our findings suggest that both TAVR and SAVR are viable options for treating severe AS in patients with small aortic annuli. TAVR offers advantages in reducing PPM and major bleeding, whereas SAVR performs better in terms of pacemaker implantation rates. Consideration of patient characteristics is crucial in selecting the optimal treatment approach for severe AS. Categories: STRUCTURAL: Valvular Disease: Aortic.
Volume
84
Issue
18
First Page
B365
Last Page
B366
