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Transcatheter vs Surgical Aortic Valve Replacement for Aortic Stenosis in Low-Intermediate Risk Patients: A Meta-analysis.

Abstract Transcatheter aortic valve replacement (TAVR) has emerged as the treatment of choice for patients with severe aortic stenosis at high surgical risk; the role of TAVR compared with surgical aortic valve replacement (SAVR) in the low-intermediate surgical risk population remains uncertain. Our primary objective was to determine differences in 30-day and late mortality in patients treated with TAVR compared with SAVR at low-intermediate risk (Society of Thoracic Surgeons Predicted Risk of Mortality < 10%).
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the canadian journal of cardiology
Publication Year Start




PMID- 28843328
OWN - NLM
STAT- In-Process
DA  - 20170827
LR  - 20170827
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 33
IP  - 9
DP  - 2017 Sep
TI  - Transcatheter vs Surgical Aortic Valve Replacement for Aortic Stenosis in
      Low-Intermediate Risk Patients: A Meta-analysis.
PG  - 1171-1179
LID - S0828-282X(17)30311-2 [pii]
LID - 10.1016/j.cjca.2017.06.005 [doi]
AB  - BACKGROUND: Transcatheter aortic valve replacement (TAVR) has emerged as the
      treatment of choice for patients with severe aortic stenosis at high surgical
      risk; the role of TAVR compared with surgical aortic valve replacement (SAVR) in 
      the low-intermediate surgical risk population remains uncertain. Our primary
      objective was to determine differences in 30-day and late mortality in patients
      treated with TAVR compared with SAVR at low-intermediate risk (Society of
      Thoracic Surgeons Predicted Risk of Mortality &lt; 10%). METHODS: Medline and Embase
      were searched from 2010 to March 2017 for studies that compared TAVR with SAVR in
      the low-intermediate surgical risk population, restricted to randomized clinical 
      trials and matched observational studies. Two investigators independently
      abstracted the data and a random effects meta-analysis was performed. RESULTS:
      Four randomized clinical trials (n = 4042) and 9 propensity score-matched
      observational studies (n = 4192) were included in the meta-analysis (n = 8234).
      There was no difference in 30-day mortality between TAVR and SAVR (3.2% vs 3.1%, 
      pooled risk ratio: 1.02; 95% confidence interval, 0.80-1.30; P = 0.89; I2 = 0%)
      or mortality at a median of 1.5-year follow-up (incident rate ratio: 1.01; 95%
      confidence interval, 0.90-1.15; P = 0.83; I2 = 0%). There was a higher risk of
      pacemaker implantation and greater than trace aortic insufficiency in the TAVR
      group whereas the risk of early stroke, atrial fibrillation, acute kidney injury,
      cardiogenic shock, and major bleeding was higher in the SAVR group. CONCLUSIONS: 
      Although there was no difference in 30-day and late mortality, the rate of
      complications differed between TAVR and SAVR in the low-intermediate surgical
      risk population.
CI  - Copyright (c) 2017 Canadian Cardiovascular Society. Published by Elsevier Inc.
      All rights reserved.
FAU - Tam, Derrick Y
AU  - Tam DY
AD  - Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre,
      Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario,
      Canada; Institute of Health Policy, Management and Evaluation, University of
      Toronto, Toronto, Ontario, Canada.
FAU - Vo, Thin Xuan
AU  - Vo TX
AD  - School of Medicine, Queen's University, Kingston, Ontario, Canada.
FAU - Wijeysundera, Harindra C
AU  - Wijeysundera HC
AD  - Institute of Health Policy, Management and Evaluation, University of Toronto,
      Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine,
      Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Ontario, Canada.
FAU - Ko, Dennis T
AU  - Ko DT
AD  - Institute of Health Policy, Management and Evaluation, University of Toronto,
      Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine,
      Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Ontario, Canada.
FAU - Rocha, Rodolfo Vigil
AU  - Rocha RV
AD  - Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre,
      Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario,
      Canada.
FAU - Friedrich, Jan
AU  - Friedrich J
AD  - Division of Critical Care Medicine, Department of Medicine, St Michael's
      Hospital, University of Toronto, Toronto, Ontario, Canada.
FAU - Fremes, Stephen E
AU  - Fremes SE
AD  - Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre,
      Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario,
      Canada; Institute of Health Policy, Management and Evaluation, University of
      Toronto, Toronto, Ontario, Canada. Electronic address:
      [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170615
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
EDAT- 2017/08/28 06:00
MHDA- 2017/08/28 06:00
CRDT- 2017/08/28 06:00
PHST- 2017/05/23 [received]
PHST- 2017/06/06 [revised]
PHST- 2017/06/09 [accepted]
AID - S0828-282X(17)30311-2 [pii]
AID - 10.1016/j.cjca.2017.06.005 [doi]
PST - ppublish
SO  - Can J Cardiol. 2017 Sep;33(9):1171-1179. doi: 10.1016/j.cjca.2017.06.005. Epub
      2017 Jun 15.