A meta-analysis of effects of transcatheter versus surgical aortic valve replacement on left ventricular ejection fraction and mass

Objectives: To determine which procedure, transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR), for severe aortic stenosis (AS) improves follow-up left ventricular (LV) function or hypertrophy more effectively, we performed the first meta-analysis of comparative studies reporting LV ejection fraction (LVEF) or mass (LVM) after TAVI versus SAVR.

Methods: Studies considered for inclusion met the following criteria: the article was written in English; the design was a comparative study; the study population was patients with severe AS; patients were assigned to TAVI versus SAVR; and outcomes included follow-up (6-12-month) LVEF or LVM. For each study, data regarding fractional changes in LVEF or LVM in both the TAVI and SAVR groups were used to generate mean differences (MDs) and 95% confidence intervals (CIs).

Results: Our search identified 8 eligible studies. Two studies with baseline LVEF<40% demonstrated significantly greater fractional changes in LVEF after TAVI than after SAVR. A pooled analysis of 6 studies demonstrated no statistically significant difference in fractional changes in LVEF between TAVI and SAVR (MD, 3.25%; 95% CI, -1.30% to 7.80%; p=0.16). Another pooled analysis of 5 studies demonstrated significantly greater fractional changes (i.e. less fractional "reductions") in LVM after TAVI than after SAVR (MD, 4.75%; 95% CI, 2.18% to 7.32%; p=0.0003).

Conclusions: For patients with severe AS, SAVR may be associated with greater improvement in LVM, probably not in LVEF, at 6-12 months. For limited patients with reduced LVEF, TAVI might be associated with greater improvement in LVEF.