Journal of the Saudi Heart Association · 2024
Comparative Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Elderly Patients With Severe Symptomatic Aortic Stenosis: A Systematic Review.
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Hamodat Omar, Almuzainy Saif, Nizar Salma
Аннотация
OBJECTIVES: Aortic stenosis is the most common valvular heart disease globally; while transcatheter aortic valve replacement (TAVR) has proven to be a competitive alternative to surgical aortic valve replacement (SAVR) and revolutionized treatment, its safety and efficacy has yet to be comprehensively assessed against SAVR for certain subsets of aortic stenosis patients; therefore, this study aims to systematically analyze all the available clinical evidence from randomized clinical trials on TAVR versus SAVR among intermediate and low-risk patients with severe symptomatic aortic stenosis.
METHODOLOGY: We performed a systematic review of the randomized controlled trials (RCT), studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a comprehensive search of the major databases. Mortality, stroke, length of stay, and other perioperative outcomes were assessed.
RESULTS: A comprehensive screening of 14,384 records identified 9 studies, encompassing 8884 patients with a mean age of 77.76 years and 49.47% male. TAVR demonstrated a significantly lower all-cause mortality at both 30 days and 1 year compared to SAVR, with comparable outcomes at 2 years, underscoring its potential for enhanced survival. Stroke incidence was markedly lower with TAVR at both 30 days and 1 year, highlighting its favorable neurological safety profile. Additionally, TAVR showed a reduced rate of myocardial infarction within the initial 30 days post-procedure. Prosthetic valve endocarditis rates remained low and comparable between the two approaches at both 30 days and 1 year. Notably, TAVR was associated with a significantly shorter hospital stay, suggesting a faster recovery trajectory and improved patient throughput. These findings collectively emphasize the superior efficacy and safety profile of TAVR over SAVR.
CONCLUSION: TAVR may serve as a viable therapeutic option for intermediate and low-risk patients with severe symptomatic aortic stenosis. Future research should focus on long-term outcomes and TAVR device durability, especially in younger, lower-risk populations.
METHODOLOGY: We performed a systematic review of the randomized controlled trials (RCT), studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a comprehensive search of the major databases. Mortality, stroke, length of stay, and other perioperative outcomes were assessed.
RESULTS: A comprehensive screening of 14,384 records identified 9 studies, encompassing 8884 patients with a mean age of 77.76 years and 49.47% male. TAVR demonstrated a significantly lower all-cause mortality at both 30 days and 1 year compared to SAVR, with comparable outcomes at 2 years, underscoring its potential for enhanced survival. Stroke incidence was markedly lower with TAVR at both 30 days and 1 year, highlighting its favorable neurological safety profile. Additionally, TAVR showed a reduced rate of myocardial infarction within the initial 30 days post-procedure. Prosthetic valve endocarditis rates remained low and comparable between the two approaches at both 30 days and 1 year. Notably, TAVR was associated with a significantly shorter hospital stay, suggesting a faster recovery trajectory and improved patient throughput. These findings collectively emphasize the superior efficacy and safety profile of TAVR over SAVR.
CONCLUSION: TAVR may serve as a viable therapeutic option for intermediate and low-risk patients with severe symptomatic aortic stenosis. Future research should focus on long-term outcomes and TAVR device durability, especially in younger, lower-risk populations.