Affiliation:
1. Faculty of Medicine and Dentistry, University of Plymouth, Plymouth
2. Swansea University Medical School, Wales
3. Faculty of Health, University of Plymouth, Plymouth
4. Wessex Cardiac Centre, Southampton
5. Southwest Cardiothoracic Centre, Plymouth, UK
Abstract
Objectives
This meta-analysis aims to compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) versus aortic valve replacement (AVR) for aortic stenosis in dialysis-dependent patients.
Methods
Literature searches employed PubMed, Web of Science, Google Scholar and Embase to identify relevant studies. Bias-treated data were prioritized, isolated and pooled for analysis; raw data were utilized where bias-treated data were unavailable. Outcomes were analysed to assess for study data crossover.
Results
Literature search identified 10 retrospective studies; following data source analysis, five studies were included. Upon pooling of bias-treated data, TAVI was significantly favoured in early mortality [odds ratio (OR), 0.42; 95% confidence interval (95% CI), 0.19–0.92; I
2 = 92%; P = 0.03], 1-year mortality (OR, 0.88; 95% CI 0.80–0.97; I
2 = 0%; P = 0.01), rates of stroke/cerebrovascular events (OR, 0.71; 95% CI 0.55–0.93; I
2 = 0%; P = 0.01) and blood transfusions (OR, 0.36; 95% CI 0.21–0.62; I
2 = 86%; P = 0.0002). Pooling demonstrated fewer new pacemaker implantations in the AVR group (OR, 3.33; 95% CI 1.94–5.73; I
2 = 74%; P ≤ 0.0001) and no difference in the rate of vascular complications (OR, 2.27; 95% CI 0.60–8.59; I
2 = 83%; P = 0.23). Analysis including raw data revealed the length of hospital stay to favour TAVI with a mean difference of –9.20 days (95% CI –15.58 to –2.82; I
2 = 97%; P = 0.005).
Conclusion
Bias-treated meta-analysis comparing surgical AVR and TAVI favoured TAVI in early mortality, 1-year mortality, rates of stroke/cerebrovascular events and blood transfusions. There was no difference in the rates of vascular complications; however, TAVI required more pacemaker implantations. Data pooling including raw data revealed that the length of hospital admission favours TAVI.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine,General Medicine