Meta-analysis reveals TAVI survival benefits
medwireNews: A meta-analysis shows significantly reduced mortality during the 2 years after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).
Across four randomised trials with 3806 participants, TAVI was associated with a significant 13% reduction in the risk of all-cause mortality versus SAVR, report Stephan Windecker (Bern University Hospital, Switzerland) and co-workers.
They say that the majority of individual trials were powered only for noninferiority, making their analysis the first to provide “reliable evidence of a cumulative survival benefit” associated with TAVI, although they add that there are as yet no available data for mortality beyond 5 years.
As reported in the European Heart Journal, Windecker and team found the benefits of TAVI were driven largely by better outcomes in women and in patients undergoing the procedure via a transfemoral approach.
Women had a 32% reduced mortality risk with TAVI versus SAVR, whereas men derived no additional benefit from the interventional procedure. And patients undergoing transfemoral TAVI had a significant 20% reduction in risk, whereas outcomes in those undergoing transthoracic TAVI were no better than in patients undergoing SAVR.
This “robust survival benefit” with transfemoral TAVI “is consistent with previous reports and may be related at least in part to the less invasive nature of the intervention”, say the researchers.
They add: “While TAVI by transthoracic access is an important treatment alternative to SAVR among carefully selected patients (those who cannot undergo transfemoral TAVI), the relevance of transfemoral TAVI will further increase owing to the continued refinement of delivery catheters and downsizing of the introducer sheath diameters with newer-generation devices.”
The reduced mortality risk with TAVI was unaffected by patients having high or low/intermediate surgical risk, and by whether a balloon-expandable or self-expandable system was used.
The team notes that the improved survival associated with TAVI “may also be attributed to the lower incidence of several key secondary outcomes”.
Patients undergoing TAVI had significant reductions in the risk of kidney injury (by 39%), new-onset atrial fibrillation (54%) and major bleeding (43%). Conversely, SAVR was associated with a significantly reduced risk of major vascular complications and permanent pacemaker implantation.
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