COMPARATIVE EFFECTIVENESS OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) VERSUS SURGICAL AORTIC VALVE REPLACEMENT (SAVR): A COMPREHENSIVE REVIEW
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Abstract
“Aortic stenosis” (AS) is a cardiac condition in which the aorta narrows down which creates a hindrance to the flow of blood. This ultimately leads to increased pressure in the left ventricle which increases the risk of heart failure. Aortic stenosis was previously managed as Surgical Aortic Valve Replacement which was the gold standard till the previous decade. Recently, a more innovative approach, Transcatheter Aortic Valve Replacement (TAVR) is used. The goal of both these treatment methods is to replace the dysfunctional valve with a functional substitute. TAVR has been shown to be a better alternative to SAVR. However, there is a scarcity of research comparing the outcomes of TAVR and SAVR. Limited research is available on the comparison between TAVR and SAVR. The purpose of this review article is to compare the outcomes of TAVR vs SAVR in various studies.
References
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5. Benetti FJ, Mariani MA, Rizzardi JL, Benetti I. Minimally invasive aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery. 1997 Apr;113(4):806–7.
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7. Vallabhajosyula P, Bavaria JE. Transcatheter aortic valve implantation: complications and management. The Journal of Heart Valve Disease [Internet]. 2011 Sep 1;20(5):499–509. Available from: https://pubmed.ncbi.nlm.nih.gov/22066353/
8. Conte JV, Hermiller J, Resar JR, Deeb GM, Gleason TG, Adams DH, et al. Complications After Self-expanding Transcatheter or Surgical Aortic Valve Replacement. Seminars in Thoracic and Cardiovascular Surgery. 2017;29(3):321–30.
9. Fusari M, Bona V, Muratori M, Salvi L, Salis S, Tamborini G, et al. Transcatheter vs. surgical aortic valve replacement. Journal of Cardiovascular Medicine. 2012 Apr;13(4):229–41.
10. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. New England Journal of Medicine. 2011 Jun 9;364(23):2187–98.
11. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. New England Journal of Medicine. 2019 May 2;380(18):1695–705.
12. Muhammad Shayan Khan, Mir T, Ullah W, Ali Z, Idris O, Khan G, et al. Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review. Cardiology research. 2020 Jan 1;11(3):168–78.
13. Fliegner MA, Devraj Sukul, Thompson MP, Shah N, Reza M, McCullough JS, et al. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions. IJC Heart & Vasculature. 2021 Oct 1;36:100864–4.
14. Jansen W, Nierich AP, Peelen LM, Brandon GJ, Dambrink JHE, Karel G.M. Moons, et al. Survival and quality of life after surgical aortic valve replacement in octogenarians. Journal of Cardiothoracic Surgery. 2016 Mar 19;11(1).
15. Sílvia Marta Oliveira, Ana Sofia Correia, MILENA GOUVEIA PAIVA, Gonçalves A, Pereira M, Alves E, et al. Long-Term Survival, Autonomy, and Quality of Life of Elderly Patients Undergoing Aortic Valve Replacement. Journal of Cardiac Surgery. 2011 Dec 28;27(1):20–3.
16. Reynolds MR, Magnuson EA, Wang K, Thourani VH, Williams M, Zajarias A, et al. Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis. Journal of the American College of Cardiology. 2012 Aug;60(6):548–58.
17. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine. 2016 Apr 28;374(17):1609–20.
18. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. New England Journal of Medicine. 2020 Feb 27;382(9):799–809.
19. Baron SJ, Magnuson EA, Lu M, Wang K, Chinnakondepalli K, Mack M, et al. Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Journal of the American College of Cardiology [Internet]. 2019 Dec 10;74(23):2833–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31577923
20. Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, et al. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. Journal of Clinical Medicine [Internet]. 2021 Oct 28 [cited 2022 Apr 23];10(21):5046. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584339/
21. Virtanen MPO, Eskola M, Jalava MP, Husso A, Laakso T, Niemelä M, et al. Comparison of Outcomes After Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement Among Patients With Aortic Stenosis at Low Operative Risk. JAMA Network Open. 2019 Jun 14;2(6):e195742.
22. Lou Y, Gao Y, Yu Y, Li Y, Xi Z, Swe KNC, et al. Efficacy and Safety of Transcatheter vs. Surgical Aortic Valve Replacement in Low-to-Intermediate-Risk Patients: A Meta-Analysis. Frontiers in Cardiovascular Medicine. 2020 Nov 16;7.
23. Saia F, Lemos PA, Bordoni B, Cervi E, Boriani G, Ciuca C, et al. Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis: prediction of the need for permanent pacemaker using simple baseline and procedural characteristics. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions [Internet]. 2012 Apr 1 [cited 2024 Jun 1];79(5):712–9. Available from: https://pubmed.ncbi.nlm.nih.gov/22109957/
24. Généreux P, Cohen DJ, Williams MR, Mack M, Kodali SK, Svensson LG, et al. Bleeding Complications After Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology [Internet]. 2014 Mar [cited 2019 Oct 24];63(11):1100–9. Available from: https://ahs.pure.elsevier.com/en/publications/bleeding-complications-after-surgical-aortic-valve-replacement-co
25. Siemieniuk RA, Agoritsas T, Manja V, Devji T, Chang Y, Bala MM, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. BMJ [Internet]. 2016 Sep 28;i5130. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040923/
26. Baron SJ, Wang K, House JA, Magnuson EA, Reynolds MR, Makkar R, et al. Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk. Circulation. 2019 Feb 12;139(7):877–88.
27. Reynolds MR, Magnuson EA, Lei Y, Wang K, Vilain K, Li H, et al. Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis. Journal of the American College of Cardiology. 2012 Dec;60(25):2683–92.
28. Brescia AA, Syrjamaki JD, Regenbogen SE, Paone G, Pruitt AL, Shannon FL, et al. Transcatheter Versus Surgical Aortic Valve Replacement Episode Payments and Relationship to Case Volume. The Annals of Thoracic Surgery. 2018 Dec;106(6):1735–41.
29. Abugroun A, Osman M, Awadalla S, Klein LW. Outcomes of Transcatheter Aortic Valve Replacement With Percutaneous Coronary Intervention versus Surgical Aortic Valve Replacement With Coronary Artery Bypass Grafting. The American Journal of Cardiology. 2020 Dec;137:83–8.
30. Dhaval Kolte, Khera S, Muhammad Rizwan Sardar, Gheewala N, Gupta T, Chatterjee S, et al. Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States. Circulation-cardiovascular Interventions. 2017 Jan 1;10(1).
31. Goldsweig AM, Tak HJ, Chen LW, Aronow HD, Shah B, Kolte D, et al. Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy. Circulation: Cardiovascular Interventions. 2020 May;13(5).
2. Mahmaljy H, Tawney A, Young M. Transcatheter Aortic Valve Replacement [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431075/#:~:text=In%202002%2C%20Dr.
3. Ramlawi B, Ramchandani M, Reardon MJ. Surgical Approaches to Aortic Valve Replacement and Repair—Insights and Challenges. Interventional Cardiology Review. 2011;9(1):32.
4. Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. The Annals of Thoracic Surgery [Internet]. 1996 Aug 1 [cited 2024 May 31];62(2):596–7. Available from: https://pubmed.ncbi.nlm.nih.gov/8694642/
5. Benetti FJ, Mariani MA, Rizzardi JL, Benetti I. Minimally invasive aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery. 1997 Apr;113(4):806–7.
6. Gundry SR, Shattuck OH, Razzouk AJ, Rio MJ del, Sardari FF, Bailey LL. Facile Minimally Invasive Cardiac Surgery via Ministernotomy. The Annals of Thoracic Surgery [Internet]. 1998 Apr 1 [cited 2020 Nov 20];65(4):1100–4. Available from: https://www.annalsthoracicsurgery.org/article/S0003-4975(98)00064-2/fulltext
7. Vallabhajosyula P, Bavaria JE. Transcatheter aortic valve implantation: complications and management. The Journal of Heart Valve Disease [Internet]. 2011 Sep 1;20(5):499–509. Available from: https://pubmed.ncbi.nlm.nih.gov/22066353/
8. Conte JV, Hermiller J, Resar JR, Deeb GM, Gleason TG, Adams DH, et al. Complications After Self-expanding Transcatheter or Surgical Aortic Valve Replacement. Seminars in Thoracic and Cardiovascular Surgery. 2017;29(3):321–30.
9. Fusari M, Bona V, Muratori M, Salvi L, Salis S, Tamborini G, et al. Transcatheter vs. surgical aortic valve replacement. Journal of Cardiovascular Medicine. 2012 Apr;13(4):229–41.
10. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. New England Journal of Medicine. 2011 Jun 9;364(23):2187–98.
11. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. New England Journal of Medicine. 2019 May 2;380(18):1695–705.
12. Muhammad Shayan Khan, Mir T, Ullah W, Ali Z, Idris O, Khan G, et al. Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review. Cardiology research. 2020 Jan 1;11(3):168–78.
13. Fliegner MA, Devraj Sukul, Thompson MP, Shah N, Reza M, McCullough JS, et al. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions. IJC Heart & Vasculature. 2021 Oct 1;36:100864–4.
14. Jansen W, Nierich AP, Peelen LM, Brandon GJ, Dambrink JHE, Karel G.M. Moons, et al. Survival and quality of life after surgical aortic valve replacement in octogenarians. Journal of Cardiothoracic Surgery. 2016 Mar 19;11(1).
15. Sílvia Marta Oliveira, Ana Sofia Correia, MILENA GOUVEIA PAIVA, Gonçalves A, Pereira M, Alves E, et al. Long-Term Survival, Autonomy, and Quality of Life of Elderly Patients Undergoing Aortic Valve Replacement. Journal of Cardiac Surgery. 2011 Dec 28;27(1):20–3.
16. Reynolds MR, Magnuson EA, Wang K, Thourani VH, Williams M, Zajarias A, et al. Health-Related Quality of Life After Transcatheter or Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis. Journal of the American College of Cardiology. 2012 Aug;60(6):548–58.
17. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. New England Journal of Medicine. 2016 Apr 28;374(17):1609–20.
18. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. New England Journal of Medicine. 2020 Feb 27;382(9):799–809.
19. Baron SJ, Magnuson EA, Lu M, Wang K, Chinnakondepalli K, Mack M, et al. Health Status After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Journal of the American College of Cardiology [Internet]. 2019 Dec 10;74(23):2833–42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31577923
20. Mach M, Okutucu S, Kerbel T, Arjomand A, Fatihoglu SG, Werner P, et al. Vascular Complications in TAVR: Incidence, Clinical Impact, and Management. Journal of Clinical Medicine [Internet]. 2021 Oct 28 [cited 2022 Apr 23];10(21):5046. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584339/
21. Virtanen MPO, Eskola M, Jalava MP, Husso A, Laakso T, Niemelä M, et al. Comparison of Outcomes After Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement Among Patients With Aortic Stenosis at Low Operative Risk. JAMA Network Open. 2019 Jun 14;2(6):e195742.
22. Lou Y, Gao Y, Yu Y, Li Y, Xi Z, Swe KNC, et al. Efficacy and Safety of Transcatheter vs. Surgical Aortic Valve Replacement in Low-to-Intermediate-Risk Patients: A Meta-Analysis. Frontiers in Cardiovascular Medicine. 2020 Nov 16;7.
23. Saia F, Lemos PA, Bordoni B, Cervi E, Boriani G, Ciuca C, et al. Transcatheter aortic valve implantation with a self-expanding nitinol bioprosthesis: prediction of the need for permanent pacemaker using simple baseline and procedural characteristics. Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions [Internet]. 2012 Apr 1 [cited 2024 Jun 1];79(5):712–9. Available from: https://pubmed.ncbi.nlm.nih.gov/22109957/
24. Généreux P, Cohen DJ, Williams MR, Mack M, Kodali SK, Svensson LG, et al. Bleeding Complications After Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology [Internet]. 2014 Mar [cited 2019 Oct 24];63(11):1100–9. Available from: https://ahs.pure.elsevier.com/en/publications/bleeding-complications-after-surgical-aortic-valve-replacement-co
25. Siemieniuk RA, Agoritsas T, Manja V, Devji T, Chang Y, Bala MM, et al. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. BMJ [Internet]. 2016 Sep 28;i5130. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040923/
26. Baron SJ, Wang K, House JA, Magnuson EA, Reynolds MR, Makkar R, et al. Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk. Circulation. 2019 Feb 12;139(7):877–88.
27. Reynolds MR, Magnuson EA, Lei Y, Wang K, Vilain K, Li H, et al. Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Surgical Aortic Valve Replacement in High-Risk Patients With Severe Aortic Stenosis. Journal of the American College of Cardiology. 2012 Dec;60(25):2683–92.
28. Brescia AA, Syrjamaki JD, Regenbogen SE, Paone G, Pruitt AL, Shannon FL, et al. Transcatheter Versus Surgical Aortic Valve Replacement Episode Payments and Relationship to Case Volume. The Annals of Thoracic Surgery. 2018 Dec;106(6):1735–41.
29. Abugroun A, Osman M, Awadalla S, Klein LW. Outcomes of Transcatheter Aortic Valve Replacement With Percutaneous Coronary Intervention versus Surgical Aortic Valve Replacement With Coronary Artery Bypass Grafting. The American Journal of Cardiology. 2020 Dec;137:83–8.
30. Dhaval Kolte, Khera S, Muhammad Rizwan Sardar, Gheewala N, Gupta T, Chatterjee S, et al. Thirty-Day Readmissions After Transcatheter Aortic Valve Replacement in the United States. Circulation-cardiovascular Interventions. 2017 Jan 1;10(1).
31. Goldsweig AM, Tak HJ, Chen LW, Aronow HD, Shah B, Kolte D, et al. Relative Costs of Surgical and Transcatheter Aortic Valve Replacement and Medical Therapy. Circulation: Cardiovascular Interventions. 2020 May;13(5).
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Jun 20, 2024
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Dr Hashim Mahmood, Dr Syed Abdullah Haider, Dr Muhammad Bilal Anwar, Dr Mohammad Ismail Asim, Dr Sidra Hariss, Dr Alian Fatima, Dr Khathijatul Qubra, Dr Ashtar Kariem, Dana Al Tarawneh, & Dr Muhammad Ali Hassan. (2024). COMPARATIVE EFFECTIVENESS OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) VERSUS SURGICAL AORTIC VALVE REPLACEMENT (SAVR): A COMPREHENSIVE REVIEW. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 1411-1417. https://doi.org/10.53555/jptcp.v31i6.6685
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Author Biographies
Dr Hashim Mahmood
1*University of Lahore, https://orcid.org/0009-0002-7982-627X
Dr Syed Abdullah Haider
University College of Medicine and Dentistry, Lahore,
Dr Muhammad Bilal Anwar
Shifa College of Medicine/ Shifa International Hospital Islamabad Pakistan, https://orcid.org/0000-0001-7721-8276
Dr Mohammad Ismail Asim
Shifa College of Medicine /Shifa International Hospital Islamabad Pakistan
Dr Sidra Hariss
Gulf Medical University, https://orcid.org/0009-0005-6759-9569
Dr Alian Fatima
RAK Medical and Health Sciences University, RAK, UAE, https://orcid.org/0009-0005-1902-615X
Dr Khathijatul Qubra
MBBS Gulf Medical University,
Dr Ashtar Kariem
Post Graduate Clinical Trainee under SGH
Dana Al Tarawneh
RAK Medical and Health Sciences University, https://orcid.org/0000-0002-0322-5120
Dr Muhammad Ali Hassan
Shifa College of Medicine/ Shifa International Hospital, Islamabad, Pakistan
How to Cite
Dr Hashim Mahmood, Dr Syed Abdullah Haider, Dr Muhammad Bilal Anwar, Dr Mohammad Ismail Asim, Dr Sidra Hariss, Dr Alian Fatima, Dr Khathijatul Qubra, Dr Ashtar Kariem, Dana Al Tarawneh, & Dr Muhammad Ali Hassan. (2024). COMPARATIVE EFFECTIVENESS OF TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) VERSUS SURGICAL AORTIC VALVE REPLACEMENT (SAVR): A COMPREHENSIVE REVIEW. Journal of Population Therapeutics and Clinical Pharmacology, 31(6), 1411-1417. https://doi.org/10.53555/jptcp.v31i6.6685