Este estudio,\u00a0que incluy\u00f3 dos estudios randomizados y 4 estudios observacionales en pacientes con estenosis a\u00f3rtica y bajo riesgo cl\u00ednico, mostr\u00f3 similar mortalidad en el per\u00edodo hospitalario entre TAVI y SAVR, pero una mayor sobrevida a los 3 a\u00f1os con SAVR.
\nSe incluyeron 3487 pacientes de 6 estudios, 4 de ellos observacionales y 2 randomizados. El TAVI se acompa\u00f1\u00f3 de menor insuficiencia renal y riesgo de sangrado pero mayores complicaciones vasculares e indicaci\u00f3n de marcapaso definitivo.<\/p>\n
Abstract\/Summary<\/strong><\/p>\n Background<\/em> Methods<\/em> Results<\/em> Conclusions<\/em>
\nAlthough transcatheter aortic valve replacement (TAVR) is officially indicated for high risk aortic stenosis (AS) patients, the procedure is increasingly being performed in patients who are not at high surgical risk, including a substantial number of low risk patients. However, data on the benefit of TAVR in this patient population is limited.<\/p>\n
\nWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies with propensity score matching (PSM) of TAVR versus surgical aortic valve replacement (SAVR) in patients who are at low surgical risk. The primary outcome was all-cause mortality. The secondary outcomes included stroke, myocardial infarction, bleeding, and various procedural complications.<\/p>\n
\nSix studies (2 RCTs and 4 PSM studies) totaling 3,484 patients were included. Follow-up ranged from 3 months to 3 years (median 2 years). The short-term mortality was similar with either TAVR or SAVR (2.2% for TAVR and 2.6% for SAVR, RR 0.89, 95% CI 0.56\u20131.41, P\u2009=\u20090.62), however, TAVR was associated with increased risk for intermediate-term mortality (17.2% for TAVR and 12.7% for SAVR, RR 1.45, 95% CI 1.11\u20131.89, P\u2009=\u20090.006). In terms of periprocedural complications, TAVR was associated with reduced risk for bleeding and renal failure and an increase in vascular complications and Pacemaker implantation.<\/p>\n
\nIn patients who are at low surgical risk, TAVR seems to be associated with increased mortality risk. Until more data in this population is available, SAVR should remain the treatment of choice for these patients.<\/p>\n