scholarly journals Outcomes of intermediate-risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20-year experience

2018 ◽  
Vol 92 (2) ◽  
pp. 390-398 ◽  
Author(s):  
Santiago Garcia ◽  
Rosemary Kelly ◽  
Mackenzie Mbai ◽  
Sergey Gurevich ◽  
Brett Oestreich ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Healthcare System ◽  
Veterans Affairs ◽  
Intermediate Risk ◽  
Single Center ◽  
Surgical Aortic Valve Replacement ◽  
System A ◽  
Risk Patients

scholarly journals The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

2021 ◽  
pp. 155698452097831
Author(s):  
Vinod H. Thourani ◽  
J. James Edelman ◽  
Sari D. Holmes ◽  
Tom C. Nguyen ◽  
John Carroll ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Early Mortality ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Risk Patients

Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

scholarly journals Neurological Complications After Transcatheter Versus Surgical Aortic Valve Replacement in Intermediate-Risk Patients

2018 ◽  
Vol 72 (18) ◽  
pp. 2109-2119 ◽  
Author(s):  
Andras P. Durko ◽  
Michael J. Reardon ◽  
Neal S. Kleiman ◽  
Jeffrey J. Popma ◽  
Nicolas M. Van Mieghem ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Neurological Complications ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Risk Patients
Sign in / Sign up

Export Citation Format

Share Document