TAVR safer than SAVR in terms of bleeding, acute kidney injury, atrial fibrillation
Transcatheter aortic valve replacement (TAVR) in severe symptomatic aortic stenosis (AS) patients is superior to conventional surgical aortic valve replacement (SAVR) in terms of reducing life-threatening bleeding, new-onset atrial fibrillation and acute kidney injury, a recent meta-analysis has found.
Pooled analysis of four studies (n=4,355; TAVR: n=2,222) showed that, at 2-year follow-up, TAVR was associated with a significantly lower rate of life-threatening bleeding (risk ratio [RR], 0.45; 95 percent CI, 0.28–0.73; p=0.001), acute kidney injury (RR, 0.48; 0.25–0.93; p=0.03) and new atrial fibrillation (RR, 0.46; 0.33–0.64; p<0.0001).
In contrast, TAVR was inferior to SAVR in terms of permanent pacemaker implantation (RR, 3.01; 1.04–8.72; p=0.04) and aortic-valve reintervention (RR, 3.22; 1.64–6.29; p=0.0006), both of which were significantly more frequent in TAVR patients.
There were no significant differences between the two treatments in terms of deaths (TAVR: 13.7 percent vs SAVR: 15.1 percent; RR, 0.86; 0.67–1.10; p=0.22) and cardiovascular mortality rates (8.87 percent vs 10.08 percent; RR, 0.88; 0.73–1.06; p=0.17). The incidences of stroke (RR, 0.90; 0.73–1.10; p=0.31) and myocardial infarction (RR, 0.99; 0.70–1.39; p=0.93) were also comparable between the interventions.
For the meta-analysis, the databases of PubMed, CENTRAL and EBSCO were searched for randomized controlled trials of patients with severe aortic valve stenosis at low-to-intermediate surgical risk. For inclusion, trials should have compared the safety and clinical outcomes between TAVR and SAVR.