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  • Cochrane corner: transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

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Cochrane corner
Cochrane corner: transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk
  1. Ahmed A Kolkailah1,
  2. Rami Doukky1,
  3. Marc P Pelletier2,
  4. Annabelle S Volgman3,
  5. Tsuyoshi Kaneko4,
  6. Ashraf F Nabhan5
  1. 1 Department of Medicine, Cook County Health, Chicago, Illinois, USA
  2. 2 Division of Cardiac Surgery, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
  3. 3 Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
  4. 4 Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
  1. Correspondence to Dr Ahmed A Kolkailah, Department of Medicine, Cook County Health, Chicago, IL 60612, USA; a.kolkailah{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-316661

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    Background

    Aortic valve stenosis (AS) is a growing health problem worldwide, especially in elderly populations.1 Its severity is classified by a number of clinical and echocardiographic parameters into mild, moderate and severe AS. The latter, if left untreated, can be deleterious to the affected individuals’ quality of life and may ultimately be fatal.1 Clinical manifestations of severe AS include exertional dyspnoea, chest pain and syncope.1 Surgical aortic valve replacement (SAVR) has long been the classical treatment modality for severe, symptomatic AS. SAVR has been proven to alleviate symptoms and prolong survival, rendering it the standard of care.2 In the current era, with the rapidly evolving technology and growing momentum towards minimally invasive procedures, transcatheter aortic valve implantation (TAVI) has emerged as a viable, alternative treatment option.3 TAVI has demonstrated outcomes comparable to SAVR in patients who are deemed inoperable or at a high to intermediate surgical risk.2 Nonetheless, whether TAVI improves outcomes in patients who are deemed to have a low surgical risk remains a matter of debate. Accordingly, in our Cochrane review,4 we sought to assess the comparative outcomes of TAVI and SAVR for severe AS in people with low surgical risk.

    Methods

    We conducted an exhaustive literature search for randomised controlled trials (RCTs) comparing TAVI and SAVR for severe AS in patients with low surgical risk. We included adults (≥18 years old) of both sexes. The low surgical risk was defined as a Society of Thoracic Surgery (STS) risk score or European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of <4%. We searched the following databases on 29 April 2019: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science Core Collection, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. We performed the search from inception to present with no …

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    Footnotes

    • Contributors AAK: screened studies, extracted data, assessed the risk of bias, conducted meta-analysis, drafted the full review, and approved the final version of the review. RD, MPP, ASV and TK: assessed the review critically for intellectual content and approved the final version of the review. AFN: screened studies, verified the extracted data, assessed the risk of bias, shared in conducting meta-analysis, produced the ‘summary of findings’ table, assessed the review critically for intellectual content, and approved the final version of the review. AAK and AFN are guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2019, Issue 12, DOI: /10.1002/14651858.CD013319.pub2 (see www.cochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

    • Competing interests MPP does consultancy work for Abbott Medical and LivaNova and received funds to attend a Cryolife Investigators Meeting. TK is a speaker bureau/proctor for Edwards Lifesciences, Medtronic and Abbott Vascular.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.