TY  - JOUR
AU  - Shimoda, Tomonari
AU  - Miyamoto, Yoshihisa
AU  - Shimamura, Junichi
AU  - Ueyama, Hiroki
AU  - Yokoyama, Yujiro
AU  - Sá, Michel Pompeu
AU  - Kaneko, Tsuyoshi
AU  - Ando, Tomo
AU  - Takagi, Hisato
AU  - Fukuhara, Shinichi
AU  - Kuno, Toshiki
PY  - 2024
TI  - Transcatheter versus surgical aortic valve replacement in low- to intermediate-risk patients: a meta-analysis of reconstructed time-to-event data
JF  - Annals of Cardiothoracic Surgery; Vol 14, No 2 (March 31, 2025): TAVR Explant
Y2  - 2024
KW  - 
N2  - Background: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for severe symptomatic aortic stenosis (AS), including low-risk patients. We aimed to update a systematic review and conduct a meta-analysis of reconstructed time-to-event data from randomized control trials (RCTs) in low-/intermediate-risk patients.  Methods: Systematic searches were performed in PubMed, EMBASE, Cochrane CENTRAL, and specific websites up to November 2023, for RCTs. A meta-analysis was performed using the reconstructed time-to-event data from the provided Kaplan-Meier (KM) curves from the included RCTs. The primary outcome was all-cause mortality, and the secondary outcomes included a composite outcome (all-cause mortality and disabling stroke), and heart failure rehospitalization. Landmark analysis for endpoints beyond 1 year was performed. The study protocol was registered on PROSPERO (CRD42023487893).   Results: Six RCTs with a total of 7,389 patients were included. The survival was comparable between both groups [hazard ratio (HR), 1.03; 95% confidence interval (CI): 0.93–1.14; P=0.57]. The composite outcome and heart failure rehospitalization were comparable between the two groups. Lower mortality with TAVR was observed compared to SAVR before 1 year (HR, 0.82; 95% CI: 0.68–0.98; P=0.03), while TAVR was associated with higher risk of mortality beyond 1 year (HR, 1.13; 95% CI: 1.01–1.27; P=0.04). Similarly, the TAVR group was associated with lower risk for the composite endpoint and heart failure rehospitalization before 1 year, but with higher rates beyond 1 year.   Conclusions: Among low- to intermediate-risk patients, TAVR was found to be associated with favorable outcomes in the short-term (0–1 year). However, our landmark analysis demonstrated TAVR to be associated with poorer outcomes beyond 1 year.
UR  - https://www.annalscts.com/article/view/17152