Transcatheter aortic valve implantation versus aortic valve replacement in intermediate surgical risk patients. Review of literature and meta-analysis

Introduction and objectives: Transcatheter aortic valve implantation (TAVI) has shown excellent results, and is a therapeutic alternative to aortic valve replacement for high or excessive surgical risk patients. However, there is no clear consensus about the benefits of TAVI for patients with intermediate surgical risk. A systematic review of literature and subsequent meta-analysis was carried out considering outcomes after the procedure and during the maximum available follow-up. Methods: A systematic review of literature was performed, combining three clusters of Keywords: "TAVR/TAVI/transcatheter aortic valve implantation/transcatheter aortic valve replacement"AND "intermediate risk" AND "aortic valve replacement/AVR/surgery". Studies published in the last 6 years were considered for analysis. Results: A total of 21 studies were included in the analysis, of which 4 were randomised controlled trials and 17 were observation studies, with 13 of them being propensity-score adjusted. No differences were found in terms of mortality (RR = 1.00, 95% CI: 0.99-1.02) or incidence of cerebrovascular accident (RR = 0.96, 95% CI: 0.77-1.20) during the maximum follow-up (1-3 years). A major vascular lesion (cerebrovascular accident) (RR = 4.39, 95% CI: 2.17-8.91), need of permanent pacemaker implantation (RR = 2.96, 95% CI: 2.00-4.36), and residual significant paravalvular leak (>= 2+; RR = 6.83, 95% CI: 4.64-10.05) were significantly higher in TAVI group. The incidence of atrial fibrillation (RR = 0.39, 95% CI: 0.25-0.61) and kidney failure (RR = 0,45, 95% CI: 0.28-0.72) were higher in the surgical group. Conclusions: After comparing TAVI and aortic valve replacement in patients with intermediate surgical risk using meta-analysis, no significatant differences were identified in terms of mortality or cerebrovascular accident during follow-up. However, the different profile of complications of each technique should guide patient selection by the Heart-Team in order to reduce post-procedural morbidity. (C) 2018 Sociedad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U.