Title

Meta-Analysis Comparing the Frequency of Stroke After Transcatheter Versus Surgical Aortic Valve Replacement

Document Type

Article

Publication Date

10-1-2018

Abstract

Stroke is one of the most feared complications of aortic valve replacement. Although the out-comes of transcatheter aortic valve implantation (TAVI) improved substantially over time,concerns remained about a potentially higher incidence of stroke with TAVI compared withsurgical replacement (SAVR). However, comparative data are sparse. We performed ameta-analysis comparing the incidence of stroke among patients undergoing TAVI versusSAVR. Of the 5067 studies screened, 28 eligible studies (22 propensity-score matched studiesand 6 randomized trials) were analyzed. Primary endpoints were 30-day stroke and disablingstroke. Secondary endpoints were 1-year stroke and disabling stroke. A total of 23,587patients were included, of whom 47.27% underwent TAVI and 52.72% underwent SAVR.For each endpoint, pooled estimates of odds ratio (OR) with 95% confidence interval (CI)were calculated. The pooled estimates for stroke (2.7% vs 3.1%, OR 0.86; 95% CI 0.72 to1.02; p=0.08) and disabling stroke (2.5% vs 2.9%, OR 0.96; 95% CI 0.57 to 1.62; p=0.89)were comparable following TAVI versus SAVR at 30 days. Similarly, the pooled estimatesfor stroke (5.0% vs 4.6%, OR 1.01; 95% CI 0.79 to 1.28; p=0.96) and disabling stroke(4.1% vs 4.5%, OR 0.92; 95% CI 0.92 to 1.39; p=0.71) were similar at 1 year. A sensitivityanalysis including only RCTs yielded similar results. Our meta-analysis documents compara-ble rates of strokes and disabling strokes following TAVI or SAVR both at 30 daysand 1 year.

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