TAVI matches SAVR for early and midterm mortality

By Laura Cowen

Transcatheter aortic valve implantation (TAVI) has similar early and midterm mortality to surgical aortic valve replacement (SAVR) in patients with aortic stenosis, including those at low to intermediate risk, show results of a systematic review and meta-analysis.

And when stratified by TAVI approach, transfemoral TAVI is associated with lower mortality than SAVR, Giovanni Esposito (Frederico II University of Naples, Italy) and co-researchers report.

They say: "These findings, which apply to adults with severe aortic stenosis, consolidate the role of TAVI as an alternative to SAVR."

The review of five randomised trials and 31 observational matched studies comparing mortality outcomes in patients undergoing TAVI (n=7732) or SAVR (n=8906) found no statistically significant difference between the procedures in odds of early (≤30 days) and midterm (≤1 year) all-cause mortality.

However, early mortality was a significant 32% lower for patients who received transfemoral TAVI rather than SAVR, while midterm mortality was a significant 20% lower. No such differences were observed for patients who underwent transapical TAVI.

Among the secondary outcomes studied, there were no statistically significant differences between TAVI and SAVR for early cardiovascular death or stroke.

In addition, patients who underwent TAVI had a significantly lower likelihood of periprocedural myocardial infarction (odds ratio [OR]=0.49), early major bleeding (OR=0.49), acute kidney injury (OR=0.50) and new-onset atrial fibrillation (OR=0.24), but a higher risk of pacemaker implantation (OR=2.32), vascular complications (OR=4.32) and paravalvular leak (OR=6.66) than those who received SAVR.

Long-term (2- to 5-year) mortality risk was marginally increased with TAVI versus SAVR (OR=1.28), but the difference between the two techniques was not statistically significant.

Esposito and co-authors point out that since TAVI is now recognised as a "reasonable alternative" to SAVR for patients at high surgical risk, "interest is increasing in comparative studies of TAVI and SAVR in patients at low or intermediate surgical risk."

They therefore conducted a subanalysis of the eight studies that included low to intermediate risk patients (n=6875) and found statistically nonsignificant reductions in early and midterm mortality with TAVI versus SAVR. Long-term mortality in these patients was similar for the two techniques.

The study findings are published in the Annals of Internal Medicine.

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