Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials
Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes. Objectives: We performed an updated meta-analysis...
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725000958 |
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| author | Roel Meeus Pavell Dhondt Jesslyn Hariyanto Hadiah Ashraf Caterina Lecchi Caroline O. Fischer-Bacca Leen Van Langenhoven Lennert Minten Christophe Dubois |
| author_facet | Roel Meeus Pavell Dhondt Jesslyn Hariyanto Hadiah Ashraf Caterina Lecchi Caroline O. Fischer-Bacca Leen Van Langenhoven Lennert Minten Christophe Dubois |
| author_sort | Roel Meeus |
| collection | DOAJ |
| description | Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes. Objectives: We performed an updated meta-analysis comparing TAVR with SAVR in this population. Methods: We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up. Results: We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30–1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41–0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81–1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46–0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53–0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48–1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48–1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81–1.46; p = 0.56) were not significantly different. Conclusions: TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up. |
| format | Article |
| id | doaj-art-29644b9e9c69475da9f51bc3f50ae2f3 |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
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| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-29644b9e9c69475da9f51bc3f50ae2f32025-08-20T03:44:35ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910169210.1016/j.ijcha.2025.101692Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trialsRoel Meeus0Pavell Dhondt1Jesslyn Hariyanto2Hadiah Ashraf3Caterina Lecchi4Caroline O. Fischer-Bacca5Leen Van Langenhoven6Lennert Minten7Christophe Dubois8Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Medicine, University Hospitals Leuven, Leuven, BelgiumGedung Fakultas Kedokteran UPH, Tangerang, IndonesiaRawalpindi Medical University, Rawalpindi, PakistanUniversity of Trieste, Trieste, ItalyUNIDAVI, Rio do Sul, BrazilLeuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, BelgiumDepartment of Cardiovascular Medicine, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Corresponding author at: Department of Cardiovascular Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes. Objectives: We performed an updated meta-analysis comparing TAVR with SAVR in this population. Methods: We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up. Results: We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30–1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41–0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81–1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46–0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53–0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48–1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48–1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81–1.46; p = 0.56) were not significantly different. Conclusions: TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.http://www.sciencedirect.com/science/article/pii/S2352906725000958Transcatheter aortic valve replacementSurgical aortic valve replacementLow surgical riskAortic valve diseaseNetwork meta-analysis |
| spellingShingle | Roel Meeus Pavell Dhondt Jesslyn Hariyanto Hadiah Ashraf Caterina Lecchi Caroline O. Fischer-Bacca Leen Van Langenhoven Lennert Minten Christophe Dubois Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials International Journal of Cardiology: Heart & Vasculature Transcatheter aortic valve replacement Surgical aortic valve replacement Low surgical risk Aortic valve disease Network meta-analysis |
| title | Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials |
| title_full | Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials |
| title_fullStr | Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials |
| title_full_unstemmed | Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials |
| title_short | Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials |
| title_sort | transcatheter aortic valve replacement in low risk patients an updated meta analysis of randomized controlled trials |
| topic | Transcatheter aortic valve replacement Surgical aortic valve replacement Low surgical risk Aortic valve disease Network meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725000958 |
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