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Título

Valve Hemodynamics After Transcatheter versus Surgical Aortic Valve Replacement in Patients with Small Aortic Annulus: A Meta-Analysis

Resumo

Background: Patients with small aortic annulus (SAA) have been associated with a higher incidence of suboptimal hemodynamics following aortic valve replacement. The optimal treatment for patients with aortic stenosis and SAA remains unclear. Therefore, we performed a systematic review and meta-analysis comparing valve hemodynamics between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with SAA.
Methods: We systematically searched PubMed, Embase and Cochrane for studies comparing TAVR versus SAVR for patients with SAA. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed using a random-effects model. Heterogeneity was assessed using I2 statistics and a p value <0.05 was considered significant. We used Review Manager 5.4.1 for all statistical analyses.
Results: Our meta-analysis included 8 studies with 1,656 patients, of whom 820 (49,5%) underwent TAVR. Mean age ranged from 75.5 to 85.6. In our analysis, TAVR was significantly associated with lower odds of prosthesis-patient mismatch (PPM) (OR 0.25; 95% CI 0.19 – 0.34; p<0.01; Figure 1A) showing low heterogeneity among studies (I2=10%). Furthermore, the mean aortic gradient (SMD -0.63 mmHg; 95% CI; -0.93 to -0.33 mmHg; p<0.01) was significantly lower in the TAVR group. However, the likelihood of experiencing aortic regurgitation (OR 4.93; 95% CI 1.77 to 13.7; p<0.001; Figure 1B) was lower in the SAVR cohort.
Conclusions: This meta-analysis of randomized clinical trials (RCTs) and observational studies suggests that TAVR is significantly associated with lower odds of PPM as well as a lower mean aortic gradient compared to SAVR in patients with SAA. However, SAVR is superior to TAVR regarding aortic regurgitation.

Palavras Chave

TAVI; Surgical Aortic Valve Replacement; Aortic Stenosis

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