Single-Arm Meta-Analysis of Argentine Studies Reporting In-Hospital Mortality After Aortic Valve Replacement in Low and Intermediate Risk Patients

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Abstract

Background: Current evidence favors surgical valve replacement to treat symptomatic aortic disease, except in elderly patients at 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 of this study was to perform a single-arm meta-analysis of local studies reporting in-hospital mortality after surgical aortic valve replacement 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 in MEDLINE,
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 postoperative
complications after aortic valve replacement, divided into intermediate and/or low risk patients according to the STS score or the EuroSCORE II. In 1,192 patients, in-hospital mortality was 3.1%. Weighted pooled estimates were: postoperative stroke1.3%, 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-risk cases; but this shift should be supported by meaningful evidence of its benefit over surgical valve replacement. This single-arm metaanalysis of Argentine studies presents in-hospital mortality and postoperative complications after aortic valve replacement in low and intermediate risk patients. The updated information on local results of surgery could serve as a benchmark for comparing with TAVI performance in our setting.