Single-arm Meta-analysis of Argentine Studies Reporting In-hospital Mortality After Aortic Valve Replacement in Low and Intermediate Risk Patients

Raúl Borracci, Daniel O. Navia, Vadim Kotowicz, Alejandro Machaín, Claudio C. Higa

Abstract


Background: Current evidence favors surgical valve replacement to treat symptomatic aortic disease, except in elderly patientsat increased risk for surgery, in whom transcatheter aortic valve implantation (TAVI) may be eligible.Objectives: Considering that the use of TAVI has been proposed to be extended to other groups at lower risk, the purpose ofthis study was to perform a single-arm meta-analysis of local studies reporting in-hospital mortality after surgical aortic valvereplacement in low and intermediate risk patients in Argentina, as a benchmark for comparing with local TAVI outcomes.Methods: A systematic review search strategy was performed using controlled trials and observational studies identified inMEDLINE, Embase, SCOPUS, and the Cochrane library to March 2019.Results: Among 80 studies identified through the search, 4 observational articles reported in-hospital mortality and postoperativecomplications after aortic valve replacement, divided into intermediate and/or low risk patients according to the STSscore or the EuroSCORE II. In 1,192 patients, in-hospital mortality was 3.1%. Weighted pooled estimates were: postoperativestroke1.3%, myocardial infarction 0.4%, need for definite pacemaker 2.7%, mediastinitis 1.4%, and reoperation for bleeding 2.6%.Conclusions: The proven efficacy of TAVI in high-risk patients is leading to the expansion of its indications toward lower-riskcases; but this shift should be supported by meaningful evidence of its benefit over surgical valve replacement. This single-armmeta-analysis of Argentine studies presents in-hospital mortality and postoperative complications after aortic valve replacementin low and intermediate risk patients. The updated information on local results of surgery could serve as a benchmarkfor comparing with TAVI performance in our setting.

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