Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website http://www.cardiologyres.org

Original Article

Volume 11, Number 3, June 2020, pages 168-178

Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review

Figures

Figure 1.
Figure 1. Random effect meta-analysis and forest plot of 30-day risk of mortality among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 2.
Figure 2. Publication bias of included studies in regards to 30-day mortality. X-axis: log risk ratio. Y-axis: standard error of the mean.
Figure 3.
Figure 3. Random effect meta-analysis and forest plot of 1-year risk of mortality among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 4.
Figure 4. Random effect meta-analysis and forest plot of 30-day risk of stroke among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 5.
Figure 5. Publication bias of included studies in regards to 30-day incidence of stroke. X-axis: log risk ratio. Y-axis: standard error of the mean.
Figure 6.
Figure 6. Random effect meta-analysis and forest plot of 1-year risk of stroke among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 7.
Figure 7. Random effect meta-analysis and forest plot of 30-day risk of acute kidney injury stage 2 and above among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 8.
Figure 8. Random effect meta-analysis and forest plot of 30-day risk of permanent pacemaker implantation among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 9.
Figure 9. Random effect meta-analysis and forest plot of 30-day risk of major vascular complications among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 10.
Figure 10. Random effect meta-analysis and forest plot of 30-day risk of infective endocarditis among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 11.
Figure 11. Random effect meta-analysis and forest plot of 30-day risk of infective endocarditis among patients undergoing TAVR, as compared to SAVR. TAVR: transcutaneous aortic valve replacement; SAVR: surgical aortic valve replacement.
Figure 12.
Figure 12. Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all studies combined. All seven studies with 4,869 subjects were included. Green circle indicates a low risk of bias < 25%. Red circle indicates a high risk of bias > 75%. Risk of major biases low for all studies except for Thyregod et al, in which the risk of performance and detection bias was high.
Figure 13.
Figure 13. Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. Green circle indicates low risk of bias < 25%. Red circle indicates high risk of bias > 75%. Seven studies with 4,869 subjects were included. As shown above, risk of major biases low for all studies except for Thyregod et al, in which the risk of performance and detection bias was high.

Tables

Table 1. Baseline Characteristics of All Studies
 
Study with yearDesignCountryStudy sizeMale (%)Age, mean (years)Type of valveRouteSTS or Euro score, meanQuality score***
*Age separately reported in both groups. **Included in current meta-analysis. ***Criteria used for scoring: proper randomization (score: 1 point), similarity of treatment groups in relevant variables at baseline (1 point), blinding of subjects and investigators (1 point for each), specified eligibility criteria (1 point), valid point estimates and measures of variability (1 point) and data on degree of compliance (1 point). TF: transfemoral; TA: transapical; STS: Society of Thoracic Surgeons score; RCT: randomized controlled trial.
Fraccaro et al (2015) [2]CohortItaly830324 (39.0)83.7 (2.8)Sapien XT core valveTF9.9 (6.7) (Euro)7
Mack et al (2019) (Partner 3) [3]RCTUSA950658 (69.2)73*Sapien 3 valveTF< 4% (STS)7
Popma et al (Evolut low risk) (2019) [4]RCTUSA1,403956 (65.10)74*Bio prosthesis self-expanding valveTF1.9 (0.7) (STS)7
Thyregod et al (2015) [12]RCTDenmark, Sweden280149 (53.2)79.1 (4.8)Core valveTF, TA8.6 (4.8) (Euro)5
Schymik et al (2015) [13]CohortGermany432211 (48.8)78.3 (49.9)Edwards, Sapien XT, core valve, Symetic ACURATETF8.8 (2.7) (Euro)7
Rosato et al (2016) [14]CohortFinland, Italy710415 (58.5)80.1 (5.8)Sapien XT, core valveTF, TA6.3 (2.9) (Euro)7
SURTAVI trial [15] (2018)CohortMultiple254**--Core valve (84%) or Evolut R (16%) (Medtronic, Dublin, Ireland)-< 3% (STS)7

 

Table 2. Prevalence of Comorbidities Across Studies
 
Fraccaro et al (2016) [2]Rosato et al (2016) [14]Schymik et al (2015) [13]Thyregod et al (2015) [12]Popma et al (2019) [4]Mack et al (2019) [3]
DM: diabetes mellitus; CAD: coronary artery disease; MI: myocardial infarction; NYHA: New York Heart Association.
DM (%)157 (18.9)110 (15.5)54 (19.3)155 (31.25)228 (31)
CAD (%)101 (14.2)208 (48.1)-137 (27.62)-
Previous MI (%)66 (8.0) )55 (7.712 (2.8)14 (5.0)28 (5.6)49 (6.6)
Chronic lung disease (%)136 (16.4)39 (9.0)33 (11.8)25 (5)106 (15.07)
Peripheral arteriopathy (%)144 (17.3)67 (9.4)160 (37.0)15 (5.4)-55 (7.5)
NYHA class III/IV (%)488 (58.8)362 (51.0)131 (46.8)263 (53.02)-