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P174 A Systematic Review Of Transcatheter Aortic Valve Implantation
  1. Y Jung,
  2. M Choi
  1. National Evidence-based Healthcare Collaborating Agency, Seoul, Korea

Abstract

Background Transcather Aortic Valve Implantation (TAVI) was developed as an alternative to surgical aortic valve replacement (AVR) for patients with severe symptomatic aortic stenosis (AS) and high or unacceptable surgical risk.

Objectives To evaluate the safety and effectiveness of TAVI compared with AVR or standard therapy.

Methods The searches were conducted via electronic databases including MEDLINE, EMBASE and the Cochrane Library and retrieved 1537 non-duplicate citations. Total 17 studies (2 RCT, 5 non-RCT, 10 cohort studies) were included for this review.

Results Compared with standard therapy, TAVI significantly increased major stroke (risk ratio, 3.91; 95% CI, 1.16-13.22) in two studies, although rate of major stroke was not significantly different in the TAVI compared with surgical AVR. Compared with standard therapy in inoperable patients, TAVI significantly reduced the all-cause mortality (risk ratio, 0.045, 95% CI, 0.26-0.77) at 1 year and improved functional status (NYHA functional classification). Among high-risk patients, the mortality was not significantly different in the TAVI compared with surgical AVR. However, a RCT of 699 high-risk patients who were randomised to treatment either by TAVI or by surgical AVR reported that the all-cause mortality at 1 year was 24.2% and 26.8%, respectively and TAVI was non-inferior to surgical AVR (p = 0.44).

Conclusion On the basis of current data, we recommend that TAVI is possible treatments as an alternative to surgical AVR for patients with AS who are considered to be inoperable or high risk for surgical AVR.

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