Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis
Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Me...
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2021-01-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2020.1843235 |
| _version_ | 1828080491154112512 |
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| author | Azka Latif Muhammad Junaid Ahsan Noman Lateef Vikas Kapoor Mohsin Mansoor Mirza Faiz Anwer Michael Del Core Arun Kanmantha Reddy |
| author_facet | Azka Latif Muhammad Junaid Ahsan Noman Lateef Vikas Kapoor Mohsin Mansoor Mirza Faiz Anwer Michael Del Core Arun Kanmantha Reddy |
| author_sort | Azka Latif |
| collection | DOAJ |
| description | Introduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay. Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76–1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62–0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62–0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70–1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65–4.333), p < 0.001]. Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home. |
| first_indexed | 2024-04-11T03:19:41Z |
| format | Article |
| id | doaj.art-c05c8f6c034f4e3881393b1ddb0a33ee |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T03:19:41Z |
| publishDate | 2021-01-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-c05c8f6c034f4e3881393b1ddb0a33ee2023-01-02T09:32:41ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662021-01-0111112813410.1080/20009666.2020.18432351843235Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysisAzka Latif0Muhammad Junaid Ahsan1Noman Lateef2Vikas Kapoor3Mohsin Mansoor Mirza4Faiz Anwer5Michael Del Core6Arun Kanmantha Reddy7Creighton University School of MedicineCreighton University School of MedicineCreighton University School of MedicineCreighton University School of MedicineCreighton University School of MedicineCleveland ClinicCHI Health Heart and Vascular InstituteCHI Health Heart and Vascular InstituteIntroduction: Since the approval of transcatheter aortic valve replacement (TAVR), nonagenarian group patients are being increasingly considered for TAVR. Therefore, we compared the clinical outcomes of surgical aortic valve replacement (SAVR) vs TAVR in nonagenarians with severe aortic stenosis. Methods: A literature search was performed using MEDLINE, Embase, Web of Science, Cochrane, and Clinicaltrials.gov for studies reporting the comparative outcomes of TAVR versus SAVR in nonagenarians. The primary endpoint was short-term mortality. Secondary endpoints were post-operative incidences of stroke or transient ischemic attack (TIA), vascular complications, acute kidney injury (AKI), transfusion requirement, and length of hospital stay. Results: Four retrospective studies qualified for inclusion with a total of 8,389 patients (TAVR = 3,112, SAVR = 5,277). Short-term mortality was similar between the two groups [RR = 0.91 (95% CI: 0.76–1.10), p = 0.318]. The average length of hospital stay was shorter by 3 days in the TAVR group (p = 0.037). TAVR was associated with a significantly lower risk of AKI [RR = 0.72 (95% CI: 0.62–0.83), p < 0.001] and a lower risk of transfusion [RR = 0.71 (95% CI: 0.62–0.81), p < 0.001]. There was no difference in risk of stroke/TIA[RR = 1.01 (95% CI: 0.70–1.45), p = 0.957]. The risk of vascular complications was significantly higher in the TAVR group [RR = 3.39 (95% CI: 2.65–4.333), p < 0.001]. Conclusion: In this high-risk population, TAVR compared to SAVR has similar short-term mortality benefit but has lower risks of perioperative complications and a higher number of patients being discharged to home.http://dx.doi.org/10.1080/20009666.2020.1843235nonagenarianssurgical aortic valve replacementtrans-catheter aortic valve replacementtavrsavrelderlyin-hospital outcomesshort-term outcomes |
| spellingShingle | Azka Latif Muhammad Junaid Ahsan Noman Lateef Vikas Kapoor Mohsin Mansoor Mirza Faiz Anwer Michael Del Core Arun Kanmantha Reddy Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis Journal of Community Hospital Internal Medicine Perspectives nonagenarians surgical aortic valve replacement trans-catheter aortic valve replacement tavr savr elderly in-hospital outcomes short-term outcomes |
| title | Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis |
| title_full | Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis |
| title_fullStr | Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis |
| title_full_unstemmed | Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis |
| title_short | Outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians- a systematic review and meta-analysis |
| title_sort | outcomes of surgical versus transcatheter aortic valve replacement in nonagenarians a systematic review and meta analysis |
| topic | nonagenarians surgical aortic valve replacement trans-catheter aortic valve replacement tavr savr elderly in-hospital outcomes short-term outcomes |
| url | http://dx.doi.org/10.1080/20009666.2020.1843235 |
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