Early and intermediate survival after transcatheter aortic valve implantation: systematic review and meta-analysis of 14 studies

Background: Transcatheter aortic valve implants (TAVIs) is indicated as an alternative to surgical valve replacement for patients unfit for surgery. No systematic review has studied survival after 2 years and limited information is available on between-study heterogeneity. Objectives: A systematic review and meta-analysis on intermediate survival after TAVI. Data sources: PubMed, EMBASE, Scopus and references of selected articles. Study eligibility criteria: Clinical studies evaluating TAVI, published between 2010 and 2012, reporting survival at 2 or more years. Participants: About 3500 patients from 14 studies. Study appraisal and synthesis methods: Proportion meta-analysis with 95% CI and heterogeneity assessment (I-2 and Cochran's Q). Meta-regression analysis was performed as well. Results: Pooled immediate postoperative death rate was 7.8% (95% CI 6.2% to 9.8%, I-2=40.8%; Cochran's Q=97.7 with 92.9 df, p<0.0001) and stroke rate was 3.8% (95% CI 2.8% to 5.0%, I-2=34.3%; Cochran's Q=96.5 with 92.9 df, p<0.0001). Pooled death rates at 1, 2 and 3 years were 23.2%, 31.0% and 38.6%, respectively. Among studies reporting on concomitant percutaneous coronary intervention, pooled death rates at 30 days, 1 year and 2 years were 6.3%, 17.8% and 25.8%, respectively. Limitations: Although our analysis examined a total of about 3500 patients, only a minority of these were actually followed up after 2 years. Conclusions: Pooled survival rates after TAVI (at 2 years: 69.0%; at 3 years: 61.4%) can be considered excellent, particularly in the light of the high-risk profile of this patient population. Implications of key findings: The favourable intermediate outcome in patients subjected to TAVI seems to justify its use in patients unfit for surgery. Such pooled results indicate that TAVI is a valid alternative to surgical valve replacement, but lack of data on late durability after TAVI prevents its use in low-risk patients with long expectancy of life.