Background: The comparative benefits and harms of transcatheter aortic valve intervention and surgical aortic valve replacement for high surgical risk patients with aortic stenosis haven’t shown any significant statistical and clinical difference up to 2 years. However, the comparison has not been well characterized beyond 3 years. This meta-analysis aims to assess the differential outcomes of TAVR and SAVR in high surgical risk patients enrolled in randomized controlled trials with at least 3 years of follow up.METHODS We performed a systematic literature review to identify randomized and nonrandomized clinical studies that reported at least 3 years outcomes of transcatheter aortic valve replacement vs surgical aortic valve replacement for high surgical risk patients with aortic stenosis. A total of 8 databases including Pubmed (Medline), Embase, Cochrane Library, ACP Journal Club, Scopus, DARE and Ovid containing articles from January 2000 to March 2017 were analyzed.
Results: We were able to identify and screen 748 potential eligible publications through the databases and we found 3 relevant randomized controlled trials for a total of 6321 participants. 2 evaluated the incidence of all-cause mortality at 3 years and one at 5 years. Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes beyond 3 years in term of all-cause mortality [OR (95% CI): 1.29 (0.82, 2.03)]. The incidence of stroke was not statistically significant in both groups [OR (95% CI): 0.92 (0.67, 1.27)].Nevertheless, there were a higher rate of pacemaker implantations for the TAVR group [ OR (95% CI): 2.73 (2.05, 3.64)].
Conclusion: This study confirms that all-cause mortality beyond 3 and up to 5 years in TAVR vs SAVR is not statistically significant. There is no difference in incidence of stroke either. However, there appears to have an increased risk of pacemaker placement in high risk patients undergoing TAVR compared to SAVR.