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

Document Type


Publication Date



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.