Long-term Outcomes Of Transcatheter Versus Surgical Aortic Valve Replacement In Aortic Stenosis:a Meta Analysis

Objective: To systematically evaluate the long-term efficacy(at least 5 years)of transcatheter aortic valve replacement(TAVR)and surgical aortic valve replacement(SAVR)in the treatment of aortic stenosis using the latest literatures.Methods: Search Pub Med,Cochrane Library,Web of Science and Embase databases,searching for clinical studies on TAVR and SAVR in the treatment of aortic stenosis published from January 2011 to December 2020,and the follow-up time≧5 years.Screening the literature according to the inclusion and exclusion criteria,and extracting relevant data from the selected literature,the outcomes include long-term mortality(allcause mortality and cardiogenic mortality),long-term complications(the incidence of stroke,myocardial infarction,permanent pacemaker implantation,moderate or severe aortic regurgitation,moderate or severe paravalvular leak,endocarditis and readmission),valve durability(the incidence of reoperation for aortic valve and severe structural valve deterioration,aortic valve area and mean gradient).All data were analyzed using Rev Man 5.3.Results: Nine articles were enrolled in this study with 9809 patients,including 4844 cases in TAVR group and 4965 cases in SAVR group.Meta-analysis showed that TAVR had higher long-term all-cause mortality and cardiogenic mortality than SAVR(OR=1.48,95%CI: 1.27～1.72,P<0.05;OR=1.19,95%CI: 1.03～1.36,P<0.05);and the TAVR group had higher long-term incidence of myocardial infarction(OR=1.31,95%CI: 1.04～1.65,P<0.05),permanent pacemaker implantation(OR=2.17,95%CI:1.47～3.20,P<0.05),moderate or severe aortic regurgitation(OR=8.49,95%CI:4.50～16.02,P<0.05),moderate or severe paravalvular leak(OR=17.38,95%CI:4.82～62.70,P<0.05),readmission(OR=1.38,95%CI: 1.21～1.56,P<0.05)and reoperation for aortic valve(OR=2.62,95%CI: 1.62～4.24,P<0.05),and the aortic valve area was higher in TAVR group(WMD=0.15,95%CI: 0.09～0.20,P<0.05).There were no significant difference in the incidence of stroke(OR=1.15,95%CI: 0.98～1.35,P=0.08),endocarditis(OR=1.35,95%CI: 0.87～2.09,P=0.18)and severe SVD(OR=1.09,95%CI: 0.21～5.73,P=0.92)between the two groups,and there were also no significant difference in the mean gradient between the two groups(WMD=0.13,95%CI:-2.43～2.69,P=0.92).Conclusion: Compared with SAVR,TAVR has higher long-term(within 5-7 years)allcause mortality and cardiogenic mortality.Complications such as permanent pacemaker implantation,moderate or severe aortic regurgitation and paravalvular leakage are also more common.The long-term(within 5-7 years)durability of transcatheter aortic valve is inferior to surgical biological valve,and it should be used cautiously for patients with life expectancy more than 5 years.More long-term comparative studies between TAVR and surgical bioprosthetic valves are needed to evaluate their durability.