Transcatheter aortic valve replacement significantly reduced 30-day cerebrovascular risk compared to surgical aortic valve replacement in elderly patients (OR 0.74; 95% CI 0.55-0.99; p=0.02).
Meta-Analysis (n=12,457)
Does transcatheter aortic valve replacement reduce cerebrovascular risk compared to surgical aortic valve replacement in elderly patients with severe symptomatic aortic stenosis?
TAVR is associated with a significantly lower risk of cerebrovascular events at 30 days and 1 year compared to SAVR in elderly patients, though this benefit may be attenuated by pre-existing conditions such as prior myocardial infarction or pacemaker.
Effect estimate: OR 0.74 (95% CI 0.55-0.99)
p-value: p=0.02
Background and Aims Transcatheter aortic valve replacement (TAVR) is an innovative treatment option for patients with severe symptomatic aortic stenosis. However, an analysis of cerebrovascular risk post‐TAVR compared to surgical aortic valve replacement (SAVR) in elderly patients has not been established. Methods We performed a systematic review and meta‐analysis of randomised controlled trials and observational studies by conducting a comprehensive literature search in multiple digital databases to compare the 30‐day and 1‐year cerebrovascular risk in elderly patients undergoing TAVR or SAVR. Results Our search yielded 12 studies with a total of 12,457 patients, with 7247 and 5210 in the TAVR and SAVR groups, respectively. A statistically significant reduction in cerebrovascular risk was observed at the 30‐day follow‐up for patients undergoing TAVR compared to SAVR (OR 0.74; 95% CI 0.55–0.99; p = 0.02, N = 12,231). Likewise, at the 1‐year follow‐up, TAVR demonstrated a statistically significant reduction in cerebrovascular risk compared to SAVR (OR 0.77; 95% CI 0.62–0.96; p = 0.02, N = 12,457). Meta‐regression analysis revealed that prior myocardial infarction, prior percutaneous coronary intervention and a pre‐existing pacemaker were associated with attenuation of the stroke risk advantage of TAVR at 30 days post‐op. Similarly, prior myocardial infarction and pre‐existing pacemakers were identified as risk factors at 1 year. Conclusion This review and meta‐analysis highlight the significant difference in the risk of cerebrovascular events between TAVR and SAVR. However, pre‐existing conditions modify these differences, underscoring the necessity of patient selection and risk stratification to optimise clinical outcomes.
Hooti et al. (Thu,) conducted a meta-analysis in Severe symptomatic aortic stenosis (n=12,457). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day cerebrovascular risk (OR 0.74, 95% CI 0.55-0.99, p=0.02). Transcatheter aortic valve replacement significantly reduced 30-day cerebrovascular risk compared to surgical aortic valve replacement in elderly patients (OR 0.74; 95% CI 0.55-0.99; p=0.02).