Long-term survival after transcatheter versus surgical aortic valve replacement for aortic stenosis: A meta-analysis of observational comparative studies with a propensity-score analysis

ObjectivesTo synthesize evidence regarding long-term survival after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) from real-world clinical practice, we performed a meta-analysis of observational studies with a propensity-score analysis and 3-year follow-up. MethodsDatabases including MEDLINE and EMBASE were searched through April 2017 using PubMed and OVID. Eligible studies were observational comparative studies with a propensity-score analysis of TAVI versus SAVR enrolling patients with severe AS and reporting 3-year all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) mortality for TAVI versus SAVR was extracted from each individual study. ResultsOur search identified 14 eligible studies enrolling a total of 4,197 patients. A pooled analysis of all the 14 studies demonstrated a statistically significant 54% increase in mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for effect<0.00001; P for heterogeneity=0.14; I-2=30%). Several sensitivity analyses did not substantially change the statistically significant benefit for SAVR. There was no evidence of significant publication bias. ConclusionsOn the basis of a meta-analysis of 14 observational comparative studies with a propensity-score analysis including a total of 4,000 patients, TAVI is associated with worse 3-year overall survival than SAVR.