Aortic Valve Replacement: Meta-Analysis Finds No Mortality Difference Between TAVI and SAVR

Authors: Gargiulo G et al., Ann Intern Med 2016 Jun 7;

The mortality comparisons had wide confidence intervals, however, signaling inconclusive results.

Transcatheter aortic valve implantation (TAVI) is a better option than medical therapy for people with severe aortic stenosis who cannot undergo surgical aortic valve replacement (SAVR). However, there are some conflicting results regarding whether TAVI is a better option than SAVR for those who could undergo either.

Investigators in Italy identified 5 randomized trials and 31 observational studies in a systematic review and meta-analysis that focused on mortality after TAVI and SAVR. There were no statistical group differences by risk at the time of the procedure. The two strategies showed no statistical difference in early all-cause mortality (odds ratio, 1.01; 95% confidence interval, 0.81–1.26), midterm all-cause mortality (OR, 0.96; 95% CI, 0.81–1.14), or long-term mortality (OR, 1.28; 95% CI, 0.97–1.69); analyses restricted to only the trials had similar results. Patients undergoing TAVI were more likely to have vascular complications and paravalvular leak; those undergoing SAVR were more likely to have major bleeding and acute kidney injury.

Comment This systematic review summarizes the trials and observational studies of TAVI, but the authors did not have access to individual patient data. The confidence intervals are wide, which means that the existing studies cannot exclude important effects. The fact that the study is largely inconclusive communicates that, except for the complications profile, we lack evidence about whether TAVI produces results different from SAVR results.