SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data
Background: There is debate whether surgical aortic valve replacement (SAVR) or transcatheter implantation (TAVI) provide better results for treatment of aortic valve stenosis. While randomized clinical trials (RCTs) are considered to compare the average treatment effect of two methods in a selected...
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| Format: | Article |
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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/S235290672500106X |
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| author | Tulio Caldonazo Hristo Kirov Anna Vogel Angelique Runkel Murat Mukharyamov Johannes Fischer Aryan Dadashzadeh Torsten Doenst |
| author_facet | Tulio Caldonazo Hristo Kirov Anna Vogel Angelique Runkel Murat Mukharyamov Johannes Fischer Aryan Dadashzadeh Torsten Doenst |
| author_sort | Tulio Caldonazo |
| collection | DOAJ |
| description | Background: There is debate whether surgical aortic valve replacement (SAVR) or transcatheter implantation (TAVI) provide better results for treatment of aortic valve stenosis. While randomized clinical trials (RCTs) are considered to compare the average treatment effect of two methods in a selected patient population, registry data, although biased, reflect every day clinical practice and provide external validation of RCTs. We evaluated the impact of SAVR or TAVI on long-term survival based on local reports from all available regions in the world. Methods: We systematically searched three databases selecting risk-adjusted registry studies comparing outcomes for SAVR and TAVI with at least five years of follow-up. Reports without all-cause mortality were excluded. One time-to-event curve was reconstructed from survival curves. Cox regression model and sensitivity analysis were performed. Results: From 10,399 screened studies, 13 met the inclusion criteria with 28,344 patients in the final analysis (follow-up: 5–9 years). In ten studies, survival rates favored SAVR, three showed no difference and none favored TAVI. Hazard ratio (HR) for overall survival was 0.58 (95 %CI: 0.54–0.61, p < 0.01 – favors SAVR). A landmark analysis with a 6-months split showed no significant survival difference in the first 6 months (HR: 0.94, 95 %CI: 0.86–1.02, p = 0.14) and better survival for SAVR compared to TAVI thereafter (HR: 0.43, 95 %CI: 0.40–0.46, p < 0.01). All sensitivity analyses supported this outcome. Conclusions: This systematic regional registry-type comparison revealed that SAVR is associated with increased long-term survival compared to TAVI, which appears to be independent of the world region in which the study was performed. |
| format | Article |
| id | doaj-art-86d7ec03fa0246bba08c124eeb64e17b |
| institution | DOAJ |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-86d7ec03fa0246bba08c124eeb64e17b2025-08-20T02:56:29ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910170310.1016/j.ijcha.2025.101703SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event dataTulio Caldonazo0Hristo Kirov1Anna Vogel2Angelique Runkel3Murat Mukharyamov4Johannes Fischer5Aryan Dadashzadeh6Torsten Doenst7Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyDepartment of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyCorresponding author at: Department of Cardiothoracic Surgery, University of Jena, Am Klinikum 1, 07747 Jena, Germany.; Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, GermanyBackground: There is debate whether surgical aortic valve replacement (SAVR) or transcatheter implantation (TAVI) provide better results for treatment of aortic valve stenosis. While randomized clinical trials (RCTs) are considered to compare the average treatment effect of two methods in a selected patient population, registry data, although biased, reflect every day clinical practice and provide external validation of RCTs. We evaluated the impact of SAVR or TAVI on long-term survival based on local reports from all available regions in the world. Methods: We systematically searched three databases selecting risk-adjusted registry studies comparing outcomes for SAVR and TAVI with at least five years of follow-up. Reports without all-cause mortality were excluded. One time-to-event curve was reconstructed from survival curves. Cox regression model and sensitivity analysis were performed. Results: From 10,399 screened studies, 13 met the inclusion criteria with 28,344 patients in the final analysis (follow-up: 5–9 years). In ten studies, survival rates favored SAVR, three showed no difference and none favored TAVI. Hazard ratio (HR) for overall survival was 0.58 (95 %CI: 0.54–0.61, p < 0.01 – favors SAVR). A landmark analysis with a 6-months split showed no significant survival difference in the first 6 months (HR: 0.94, 95 %CI: 0.86–1.02, p = 0.14) and better survival for SAVR compared to TAVI thereafter (HR: 0.43, 95 %CI: 0.40–0.46, p < 0.01). All sensitivity analyses supported this outcome. Conclusions: This systematic regional registry-type comparison revealed that SAVR is associated with increased long-term survival compared to TAVI, which appears to be independent of the world region in which the study was performed.http://www.sciencedirect.com/science/article/pii/S235290672500106XSurgical aortic valve replacementTranscatheter aortic valve implantationRandomized clinical trialRegistry study |
| spellingShingle | Tulio Caldonazo Hristo Kirov Anna Vogel Angelique Runkel Murat Mukharyamov Johannes Fischer Aryan Dadashzadeh Torsten Doenst SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data International Journal of Cardiology: Heart & Vasculature Surgical aortic valve replacement Transcatheter aortic valve implantation Randomized clinical trial Registry study |
| title | SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data |
| title_full | SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data |
| title_fullStr | SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data |
| title_full_unstemmed | SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data |
| title_short | SAVR and TAVI comparison across the globe based on current regional registry evidence – A meta-analysis of reconstructed time-to-event data |
| title_sort | savr and tavi comparison across the globe based on current regional registry evidence a meta analysis of reconstructed time to event data |
| topic | Surgical aortic valve replacement Transcatheter aortic valve implantation Randomized clinical trial Registry study |
| url | http://www.sciencedirect.com/science/article/pii/S235290672500106X |
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