Comparison of late mortality after transcatheter aortic valve implantation versus surgical aortic valve replacement: Insights from a meta-analysis

Introduction: Transcatheter aortic valve implantation (TAVI) has shown non-inferior late mortality in severe aortic stenosis (AS) patients in intermediate to inoperable risk for surgery compared to surgical aortic valve replacement (SAVR). Late outcome of TAVI compared to SAVR is crucial as the number of TAVI continues to increase over the last few years. Methods: A comprehensive literature search of PUBMED and EMBASE were conducted. Inclusion criteria were that [1] study design was a randomized controlled trial (RCT) or a propensity-score matched (PSM) study: [2] outcomes included >2-year all-cause mortality in both TAVI and SAVR. The random-effects model was utilized to calculate an overall effect size of TAVI compared to SAVR in all-cause mortality. Publication bias was assessed quantitatively with Egger's test. Results: A total of 14 studies with 6503 (3292 TAVI and 3211 SAVR, respectively) were included in the meta-analysis. There was no difference in late all-cause mortality between TAVI and SAVR (HR 1.17, 95% CI 0.98-1.41, p = 0.08, I-2 = 61%). The sub-group analysis of all-cause mortality of RCT (HR 0.93 95% CI 0.78-1.10, p = 0.38, I-2 = 40%) and PSM studies (HR 1.44 95% CI 1.15-1.80, p = 0.02, I-2 = 35%) differed significantly (p for subgroup differences - 0.002). Meta-regression implicated that increased age and co-existing CAD may be associated with more advantageous effects of TAVI relative to SAVR on reducing late mortality. There was no evidence of significant publication bias (p = 0.19 for Egger's test). Conclusions: TAVI conferred similar late all-causemortality compared to SAVR in a meta-analysis of RCT but had worse outcomes in a meta-analysis of PSM. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.