Title:Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: Meta-Analysis of Clinical Outcomes and Cost-Effectiveness
Volume: 22
Issue: 13
Author(s): Christopher Cao, Kevin P. Liou, Faraz K. Pathan, Sohaib Virk, Robert McMonnies, Hugh Wolfenden and Praveen Indraratna
Affiliation:
Keywords:
TAVI, transcatheter aortic valve implantation, aortic valve replacement, meta-analysis, systematic review.
Abstract: Objective: Transcatheter aortic valve implantation (TAVI) has emerged as a feasible alternative treatment
to conventional surgical aortic valve replacement (AVR) for high-risk patients with aortic stenosis. The present
systematic review aimed to assess the comparative clinical and cost-effectiveness outcomes of TAVI versus
AVR, and meta-analyse standardized clinical endpoints.
Methods: An electronic search was conducted on 9 online databases to identify all relevant studies. Eligible studies
had to report on either periprocedural mortality or incremental cost-effectiveness ratio (ICER) to be included for
analysis.
Results: The systematic review identified 24 studies that reported on comparative clinical outcomes, including three randomized controlled
trials and ten matched observational studies involving 7906 patients. Meta-analysis demonstrated no significant differences in regards
to mortality, stroke, myocardial infarction or acute renal failure. Patients who underwent TAVI were more likely to experience major
vascular complications or arrhythmias requiring permanent pacemaker insertion. Patients who underwent AVR were more likely to
experience major bleeding. Eleven analyses from 7 economic studies reported on ICER. Six analyses defined TAVI to be low value, 2
analyses defined TAVI to be intermediate value, and three analyses defined TAVI to be high value.
Conclusion: The present study demonstrated no significant differences in regards to mortality or stroke between the two therapeutic procedures.
However, the cost-effectiveness and long-term efficacy of TAVI may require further investigation. Technological improvement
and increased experience may broaden the clinical indication for TAVI for low-intermediate risk patients in the future.
