800.22 Transcatheter vs. Surgical Valve Replacement in Severe Aortic Stenosis with Small Annulus: A Meta-Analytical Review of Two-Year Outcomes
Recommended Citation
Ellauzi R, Kumar A, Ismayl M, Hamza I, Hamza T, Anavekar NS. 800.22 Transcatheter vs. Surgical Valve Replacement in Severe Aortic Stenosis with Small Annulus: A Meta-Analytical Review of Two-Year Outcomes. JACC Cardiovasc Interv 2024; 17(4):S72.
Document Type
Conference Proceeding
Publication Date
2-26-2024
Publication Title
JACC Cardiovasc Interv
Abstract
Background: The optimal approach for severe aortic stenosis (AS) patients with small aortic annulus (SAA) remains uncertain when comparing transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Methods: We conducted a pooled analysis of data from observational studies and randomized controlled trials that compared TAVR and SAVR in patients with severe aortic stenosis and small aortic annulus. The key endpoints evaluated were all-cause mortality, stroke, and myocardial infarction over a 2-year follow-up period. We used inverse variance method with Paule-Mandel estimator for tauˆ2 and Hartung-Knapp adjustment for random effects model accounting for small study effect and heterogeneity in the current analysis. All analysis was carried out using R version 4.0.3. Results: The meta-analysis incorporated data from three studies, evaluating a total of 279 TAVR and 231 SAVR patients with severe aortic stenosis and small aortic annulus. The analysis demonstrated no significant difference in all-cause mortality at 2 years follow-up, with a pooled risk ratio of 0.82 (95% CI [0.56; 1.21]), and no heterogeneity (I2 = 0%) [Figure, PANEL A]. The risk of stroke was comparable between TAVR and SAVR, with a risk ratio of 1.34 (95% CI [0.06; 28.44]) and moderate heterogeneity (I2 = 59%) [Figure, PANEL B]. Myocardial infarction was also comparable between TAVR and SAVR, yielding a risk ratio of 0.66 (95% CI [0.10; 4.15]) with no detected heterogeneity (I2 = 0%) [Figure, PANEL C]. Conclusion: In patients with severe aortic stenosis and small aortic annulus, TAVR and SAVR reported comparable results in all-cause mortality, stroke, and myocardial infarction at 2 years. Selection of valve replacement therapy should be individualized, considering these findings. [Formula presented]
Volume
17
Issue
4
First Page
S72