Five-Year Outcomes Of Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement For Treatment Of Aortic Stenosis:A Meta-analysis

Background:TAVR has become an available treatment for aortic stenosis.However,the long-term clinical outcomes remain unclear.Objective:To determine the 5-years outcomes of TAVR versus SAVR for treatment of aortic stenosis.Methods:A comprehensive search of major databases(CNKI,VIP,Wanfang,China Biomedical Literature Database(CBM),PubMed,EMBASE,The Cochrane Library)was performed from January 2010 to August 2020 for trials comparing TAVR with SAVR.All meta-analyses were conducted with the Review Manager,version 5.3(Cochrane Collaboration).Results:We identified four eligible high-quality randomized controlled trails(RCTs)including a total of 3761 patients,who were randomly assigned to undergo TAVR(n=1895 patients)and SAVR(n=1866 patients).Pooled analyses demonstrated that TAVR was associated with higher all-cause mortality,reoperation rate,rehospitalization rate and new pacemaker implantation rate than SAVR at 5year[RR=1.14,95%CI(1.06,1.22),P=0.0003;RR=3.69,95%CI(1.78,7.68),P=0.0005;RR=1.35,95%CI(1.20,1.51),P=0.00001;RR=1.90,95%CI(1.14,3.16),P=0.01];The incidence of stroke,transient cerebral ischemia,myocardial infarction,and endocarditis were not statistically different between TAVR and SAVR at 5year[RR=1.06,95%CI(0.89,1.27),P=0.50;RR=1.36,95%CI(0.97,1.83),P=0.07;RR=1.19,95%CI(0.91,1.55),P=0.21;RR=1.34,95%CI(0.88,2.05),P=0.72];New atrial fibrillation at 5 years was significantly less frequent after TAVR than after SAVR[RR=0.47,95%CI(0.40,0.55),P<0.05].Conclusion:The present meta-analysis of all the currently available RCTs suggest that SAVR may be superior to TAVR for the majority of 5-year outcomes.