Results
Figure 1 details the study selection process, illustrating a total of
2389 retrieved articles with 963 duplicates, deleted by the Endnote X9
software. After reviewing the titles and abstracts, 1394 repetitive
literature reviews, case reports, meta-analyses, and unrelated articles
were excluded. Twenty-nine items were further excluded based on the
inclusion criteria, resulting in the final 3 articles. Table 1 comprises
the details of the included studies, as 2633 patients with AS across the
3 cohorts were enrolled
(EVOLUT[8],
NOTION[9,14],
and PARTNER
III[11]). In the assessment of deviation risk, due
to specific study designs, it is
impossible to blind operators or patients (Supplement Figs A. and B.).
Summary of findings and strength of evidence (GRADE) are shown in
Supplement ( Table B. C. and D.), the quality of evidence for the most
results is evaluated as high. Because fewer than 10 studies were
included, we did not perform tests to assess publication bias.
Table 2 displays the results of all
outcome analyses. The EVOLUT trial
has yet to complete a two-year follow-up of all participants, so we did
not include the trial in our analysis of the 2-year results to avoid
bias in the analysis. The results of the 30-day, 1-year, and 2-year
follow-ups are shown in Figure 2, Figure 3, and Figure 4 respectively.
At the 30-day follow-up of the low-risk surgical patients with AS, TAVI
was associated with a lower incidence of all-cause mortality (RR, 0.44;
95% CI, 0.20 to 0.98; P = 0.04),
acute kidney injury (stage 2 or 3) (RR, 0.27; 95% CI, 0.14 to 0.56; P =
0.0003), life-threatening or significant bleeding (RR, 0.29; 95% CI,
0.14 to 0.61; P = 0.001), and NAF (RR, 0.21; 95% CI, 0.14 to 0.31;
P<0.00001), but an increased risk of PPI (RR, 3.59; 95% CI, 1.43 to
9.03; P = 0.006).
At the 1-year follow-up of the low-risk surgical patients with AS, the
cardiovascular mortality (RR,
0.56; 95% CI, 0.33 to 0.94; P = 0.03), life-threatening or significant
bleeding (RR, 0.32; 95% CI, 0.24 to 0.42; P<0.00001) and the NAF (RR,
0.25; 95% CI, 0.18 to 0.36;
P<0.00001) results in the TAVI
group were superior to those in the SAVR group, but TAVI group was
inferior to the SAVR group for the incidence of PPI (RR, 3.42; 95% CI,
1.33 to 8.82; P = 0.01).
At the 2-year follow-up of low-risk surgical patients with AS, only the
NAF results (RR, 0.27; 95% CI, 0.14 to 0.51; P<0.0001) in the TAVI
group were superior to those in the SAVR group. The differences in
all-cause mortality, cardiovascular mortality, stroke, TIA, MI, and PPI
between the TAVI and SAVR groups were not statistically significant.