Echocardiographic outcomes from seven randomized trials of transcatheter versus surgical aortic valve replacement

We performed meta-analyses of echocardiographic outcomes, including postprocedural aortic valve area (AVA), aortic valve mean pressure gradient (MPG), and paravalvular aortic regurgitation (PAR), exclusively from all currently available randomized controlled trials (RCTs) of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR).

To identify all RCTs providing echocardiographic outcomes (AVA, MPG, and PAR) up to 2 years after TAVI versus SAVR, PubMed and ClinicalTrials.gov were searched through June 2019. Mean differences in AVA (and MPG) between the TAVI and SAVR groups and odds (or hazard) ratios of at least moderate PAR for TAVI versus SAVR were pooled using the random-effects meta-analysis.

We identified seven eligible RCTs. At 30 days (P = 0.004), 1 year (P = 0.006), and 2 years (P = 0.03), AVA was significantly larger after TAVI than after SAVR. After TAVI than after SAVR, MPG was significantly lower at 30 days (P = 0.03) and 2 years (P = 0.01), and nonsignificantly lower at 1 year (P = 0.06). At 30 days (P < 0.00001), 1 year (P < 0.00001), and 2 years (P < 0.00001), incidence of at least moderate PAR was significantly greater after TAVI than after SAVR.

On the basis of the present meta-analyses of all the seven currently available RCTs, AVA is larger, MPG is lower, and incidence of at least moderate PAR is greater 30 days, 1 and 2 years after TAVI than after SAVR.