A meta-analysis of effects of transcatheter versus surgical aortic valve replacement on left ventricular ejection fraction and mass.

OBJECTIVES

To determine which procedure, transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), for severe aortic stenosis (AS) improves follow-up left ventricular (LV) function or hypertrophy more effectively, we performed the first meta-analysis of comparative studies reporting LV ejection fraction (LVEF) or mass (LVM) after TAVI versus SAVR.

METHODS

Studies considered for inclusion met the following criteria: the article was written in English; the design was a comparative study; the study population was patients with severe AS; patients were assigned to TAVI versus SAVR; and outcomes included follow-up (6-12-month) LVEF or LVM. For each study, data regarding fractional changes in LVEF or LVM in both the TAVI and SAVR groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs).

RESULTS

Our search identified 8 eligible studies. Two studies with baseline LVEF<40% demonstrated significantly greater fractional changes in LVEF after TAVI than after SAVR. A pooled analysis of 6 studies demonstrated no statistically significant difference in fractional changes in LVEF between TAVI and SAVR (MD, 3.25%; 95% CI, -1.30% to 7.80%; p=0.16). Another pooled analysis of 5 studies demonstrated significantly greater fractional changes (i.e. less fractional "reductions") in LVM after TAVI than after SAVR (MD, 4.75%; 95% CI, 2.18% to 7.32%; p=0.0003).

CONCLUSIONS

For patients with severe AS, SAVR may be associated with greater improvement in LVM, probably not in LVEF, at 6-12 months. For limited patients with reduced LVEF, TAVI might be associated with greater improvement in LVEF.