@article{ACS17152,
author = {Tomonari Shimoda and Yoshihisa Miyamoto and Junichi Shimamura and Hiroki Ueyama and Yujiro Yokoyama and Michel Pompeu Sá and Tsuyoshi Kaneko and Tomo Ando and Hisato Takagi and Shinichi Fukuhara and Toshiki Kuno},
title = {Transcatheter versus surgical aortic valve replacement in low- to intermediate-risk patients: a meta-analysis of reconstructed time-to-event data},
journal = {Annals of Cardiothoracic Surgery},
volume = {0},
number = {0},
year = {2024},
keywords = {},
abstract = {Background: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for severe symptomatic aortic stenosis (AS), including low-risk patients. We aimed to update a systematic review and conduct a meta-analysis of reconstructed time-to-event data from randomized control trials (RCTs) in low-/intermediate-risk patients.
Methods: Systematic searches were performed in PubMed, EMBASE, Cochrane CENTRAL, and specific websites up to November 2023, for RCTs. A meta-analysis was performed using the reconstructed time-to-event data from the provided Kaplan-Meier (KM) curves from the included RCTs. The primary outcome was all-cause mortality, and the secondary outcomes included a composite outcome (all-cause mortality and disabling stroke), and heart failure rehospitalization. Landmark analysis for endpoints beyond 1 year was performed. The study protocol was registered on PROSPERO (CRD42023487893).
Results: Six RCTs with a total of 7,389 patients were included. The survival was comparable between both groups [hazard ratio (HR), 1.03; 95% confidence interval (CI): 0.93–1.14; P=0.57]. The composite outcome and heart failure rehospitalization were comparable between the two groups. Lower mortality with TAVR was observed compared to SAVR before 1 year (HR, 0.82; 95% CI: 0.68–0.98; P=0.03), while TAVR was associated with higher risk of mortality beyond 1 year (HR, 1.13; 95% CI: 1.01–1.27; P=0.04). Similarly, the TAVR group was associated with lower risk for the composite endpoint and heart failure rehospitalization before 1 year, but with higher rates beyond 1 year.
Conclusions: Among low- to intermediate-risk patients, TAVR was found to be associated with favorable outcomes in the short-term (0–1 year). However, our landmark analysis demonstrated TAVR to be associated with poorer outcomes beyond 1 year.},
issn = {2304-1021}, url = {https://www.annalscts.com/article/view/17152}
}