Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes...

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Autores principales:	Ahmed Bendary, Ahmed Ramzy, Ahmed Sayed, Salma Almotawally, Karim Wilson, Malak Munir, Sameer Hirji, Abdelrahman Ibrahim Abushouk
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/183ac04a9ba045e6a1cc26fea7d63e5a
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spelling	oai:doaj.org-article:183ac04a9ba045e6a1cc26fea7d63e5a2021-11-25T04:30:05ZMinimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis10.1136/openhrt-2020-0015352053-3624https://doaj.org/article/183ac04a9ba045e6a1cc26fea7d63e5a2021-06-01T00:00:00Zhttps://openheart.bmj.com/content/8/1/e001535.fullhttps://doaj.org/toc/2053-3624Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.Ahmed BendaryAhmed RamzyAhmed SayedSalma AlmotawallyKarim WilsonMalak MunirSameer HirjiAbdelrahman Ibrahim AbushoukBMJ Publishing GrouparticleDiseases of the circulatory (Cardiovascular) systemRC666-701ENOpen Heart, Vol 8, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diseases of the circulatory (Cardiovascular) system RC666-701 Ahmed Bendary Ahmed Ramzy Ahmed Sayed Salma Almotawally Karim Wilson Malak Munir Sameer Hirji Abdelrahman Ibrahim Abushouk Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
description	Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.
format	article
author	Ahmed Bendary Ahmed Ramzy Ahmed Sayed Salma Almotawally Karim Wilson Malak Munir Sameer Hirji Abdelrahman Ibrahim Abushouk
author_facet	Ahmed Bendary Ahmed Ramzy Ahmed Sayed Salma Almotawally Karim Wilson Malak Munir Sameer Hirji Abdelrahman Ibrahim Abushouk
author_sort	Ahmed Bendary
title	Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
title_short	Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
title_full	Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
title_fullStr	Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
title_full_unstemmed	Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
title_sort	minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/183ac04a9ba045e6a1cc26fea7d63e5a
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Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis

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