Worse survival after transcatheter aortic valve implantation than surgical aortic valve replacement: A meta-analysis of observational studies with a propensity-score analysis

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• 作者：Hisato Takagi ; ^{kfgth973@ybb.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Takuya Umemoto ; for the ALICE (All-Literature Investigation of Cardiovascular Evidence) Group
• 关键词：AS ; aortic stenosis ; CABG ; coronary artery bypass grafting ; CI ; confidence interval ; EuroSCORE ; European System for Cardiac Operative Risk Evaluation ; HR ; hazard ratio ; LV ; left ventricle ; LVEF ; LV ejection fraction ; NOTION ; Nordic Aortic Valve Intervention ; OR ; odds ratio ; PAR ; paravalvular aortic regurgitation ; PARTNER ; Placement of Aortic Transcatheter Valves ; PMI ; permanent pacemaker implantation ; RCT ; randomized controlled trial ; RR ; risk ratio ; SAVR ; surgical aortic valve replacement ; STAC
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 October 2016
• 年：2016
• 卷：220
• 期：Complete
• 页码：320-327
• 全文大小：779 K

文摘

To determine whether transcatheter aortic valve implantation (TAVI) improves (or impairs) follow-up overall survival compared with surgical aortic valve replacement (SAVR), we performed a meta-analysis of observational studies with a propensity-score analysis and another meta-analysis of randomized controlled trials (RCTs).

Methods

Databases including MEDLINE and EMBASE were searched through October 2015 using PubMed and OVID. Eligible studies were observational studies with a propensity-score analysis or RCTs of TAVI versus SAVR enrolling patients with severe aortic stenosis and reporting follow-up overall survival or all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) all-cause mortality for TAVI versus SAVR was abstracted from each individual study.

Results

Our search identified 19 observational studies with a propensity-score analysis enrolling a total of 6234 patients. The arithmetic means of 1-year and 3-year survival rates were 82.7% and 71.3% after TAVI and 84.8% and 77.9% after SAVR, respectively. A pooled analysis demonstrated a statistically significant 21% increase in the hazard of mortality with TAVI relative to SAVR (HR, 1.21; 95% CI, 1.05 to 1.39; p = 0.010). Another pooled analysis of 4 RCTs (enrolling a total of 1795 patients) demonstrated no statistically significant difference in mortality between TAVI and SAVR (HR, 0.92; 95% CI, 0.62 to 1.37; p = 0.69).

Conclusions

The arithmetic mean of 3-year survival rates was 71.3% after TAVI and 77.9% after SAVR. Compared with SAVR, TAVI appears to be associated with a significant increase in follow-up all-cause mortality.