Evidence map›Paper›PMID 34670586›Full record

SynthesisJournal of cardiothoracic surgery2021

Propitious temporal changes in clinical outcomes after transcatheter compared to surgical aortic valve replacement; a meta-analysis of over 65,000 patients.

Ankur Panchal, Andreas Kyvernitakis, Geetha Rayarao, Mark Doyle, Robert W W Biederman

Abstract readMeta-Analysis
In one paragraph

Synthesis in Journal of cardiothoracic surgery, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Ankur PanchalDepartment of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Andreas KyvernitakisDepartment of Cardiovascular disease, Allegheny General Hospital, Pittsburgh, PA, USA.
Geetha RayaraoDepartment of Cardiovascular disease, Allegheny General Hospital, Pittsburgh, PA, USA.
Mark DoyleDepartment of Cardiovascular disease, Allegheny General Hospital, Pittsburgh, PA, USA.
Robert W W BiedermanDepartment of Cardiovascular disease, Allegheny General Hospital, Pittsburgh, PA, USA. Robert.Biederman@ahn.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe treatment of symptomatic severe aortic stenosis (AS) has rapidly evolved over the past decade, in both transcatheter (TAVR) and surgical aortic valve replacement (SAVR), resulting in reported improved clinical outcomes. Operator experience and technical improvements have improved outcomes especially for patients undergoing TAVR. We sought to determine and compare 1-year outcomes using a contemporary meta-analysis.

methodWe searched the Medline (MESH), Cochrane and Google scholar databases using keywords "AS", "atrial fibrillation" (AFib) and "stroke". We performed a meta-analysis to compare TAVR with SAVR populations for post-procedural stroke, all-cause and cardiovascular mortality at 1-year.

resultsA total of 23 studies met criteria for analysis with total population of 66,857 patients, of which 61,913 had TAVR and 4944 had SAVR. Temporal trends demonstrated overall improvement in outcome for both, TAVR and SAVR groups through the decade. Outcomes, in terms of stroke (3.1% vs. 5%), all-cause (12.4% vs. 10.3%) and cardiovascular mortality (7.2% vs. 6.2%) were similar at 1-year, in TAVR versus SAVR, respectively.

conclusionDespite overall gradual improvement in both TAVR and SAVR outcomes over the decade, there is a statistical overlap in confidence intervals for all-cause, cardiovascular mortality and postprocedural stroke at 1-year. While 23 individual studies demonstrate considerable advantages of each technique in certain cohorts, integrating over 65,000 pts with our stratified surgical analysis suggests that TAVR is comparable to SAVR for low and intermediate risk population while superior to SAVR only in the highest-risk population for short and intermediate term outcomes. This has substantial socio-economic implications as we contemplate expanding our TAVR indications to low/intermediate risk populations.

Indexed as

Aortic Valve StenosisHeart Valve ProsthesisHeart Valve Prosthesis ImplantationTranscatheter Aortic Valve ReplacementAortic ValveHumansAortic stenosisAtrial fibrillationMortalitySAVRStrokeTAVR

Identifiers

PMID34670586
PMCPMC8529762

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.