Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: A systematic review and meta-analysis

Symptomatic aortic stenosis has a poor prognosis. Many patients are considered inoperable or at high surgical risk for surgical aortic valve replacement (SAVR), reflecting their age, comorbidities and frailty. The clinical effectiveness and safety of TAVI have not been reviewed systematically for th...

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Bibliographic Details
Published in:PloS one 2018-05, Vol.13 (5), p.e0196877-e0196877
Main Authors: Liu, Zulian, Kidney, Elaine, Bem, Danai, Bramley, George, Bayliss, Susan, de Belder, Mark A, Cummins, Carole, Duarte, Rui
Format: Article
Language:English
Subjects:
Analysis
Anesthesia
Aorta
Aortic stenosis
Aortic valve
Aortic valve stenosis
Bleeding
Cerebral infarction
Clinical trials
Complications
Confidence intervals
Consortia
Electrocardiography
Heart
Heart failure
Implantation
Medical research
Medicine and Health Sciences
Meta-analysis
Mortality
Myocardial infarction
Patients
Physical Sciences
Prognosis
Prostheses
Quality assessment
Quality control
Quality of life
Research and Analysis Methods
Risk factors
Risk groups
Statistical analysis
Stenosis
Stroke
Surgery
Surgical instruments
Surgical outcomes
Systematic review
Therapy
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Summary:Symptomatic aortic stenosis has a poor prognosis. Many patients are considered inoperable or at high surgical risk for surgical aortic valve replacement (SAVR), reflecting their age, comorbidities and frailty. The clinical effectiveness and safety of TAVI have not been reviewed systematically for these high levels of surgical risk. This systematic review compares mortality and other important clinical outcomes up to 5 years post treatment following TAVI or other treatment in these risk groups. A systematic review protocol was registered on the PROSPERO database (CRD42016048396). The Cochrane Library, Centre for Reviews and Dissemination Databases, MEDLINE, EMBASE, and ZETOC were searched from January 2002 to August 2016. Clinical trials or matched studies comparing TAVI with other treatments for AS in patients surgically inoperable or operable at a high risk were included. Data extraction and quality assessment were conducted by two reviewers. Data were pooled using random-effects meta-analysis. The main outcomes were all-cause mortality, efficacy and major complications. Three good quality randomised controlled trials (RCTs) were included. Patients' mean age ranged from 83-85 years, around half were female and New York Heart Association (NYHA) functional class III or IV ranged from 83.8% to 94.2% with frequent comorbidities. In 358 surgically inoperable patients from one RCT, TAVI was superior to medical therapy for all-cause mortality at 1 year (hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.36-0.92), 2 years (HR 0.50, 95% CI 0.39-0.65), 3 years (HR 0.53, 95% CI 0.41to 0.68) and 5 years (HR 0.50, 95% CI 0.39-0.65), and NYHA class III or IV at 2 years (TAVI 16.8% (16/95), medical therapy 57.5% (23/40), p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0196877