TY - JOUR AU - Lloyd, Declan AU - Luc, Jessica G. Y. AU - Indja, Ben Elias AU - Leung, Vannessa AU - Wang, Nelson AU - Phan, Kevin PY - 2018 TI - Transcatheter, sutureless and conventional aortic-valve replacement: a network meta-analysis of 16,432 patients JF - Journal of Thoracic Disease; Vol 11, No 1 (January 26, 2019): Journal of Thoracic Disease Y2 - 2018 KW - N2 - Background: Minimally invasive surgical techniques pose alternatives to conventional surgery for the treatment of aortic stenosis (AS). We present a Bayesian network analysis comparing Valve Academic Research Consortium-2 clinical outcomes between transcatheter aortic valve implantation (TAVI), sutureless (SL-AVR) and conventional aortic valve replacement (CAVR). Methods: Electronic searches of databases were conducted and seven two-arm randomized-controlled trials and 25 propensity-score-matched studies comparing clinical outcomes of TAVI, SL-AVR and CAVR for treatment of AS were identified. Bayesian Markov chain Monte Carlo modelling was used to analyze clinical outcomes. Results: The analysis included 16,432 patients who underwent TAVI [7,056], SL-AVR [1,238] or CAVR [8,138]. Compared to CAVR, TAVI and SL-AVR were associated with reduced postoperative major bleeding of 59% (OR 0.41, 95% CI: 0.28–0.59) and 44% (OR 0.56, 95% CI: 0.30–0.99) respectively. TAVI had a 41% reduction in postoperative myocardial infarction (OR 0.59, 95% CI: 0.40–0.86) and SL-AVR had a 40% reduction in postoperative acute kidney injury (AKI) (OR 0.62, 95% CI: 0.42–0.86). Compared to TAVI, CAVR and SL-AVR had a reduction in moderate/severe paravalvular regurgitation of 89% (OR 0.11, 95% CI: 0.07–0.16) and 92% (OR 0.08, 95% CI: 0.03–0.17). CAVR had a 67% decreased postoperative permanent pacemaker (PPM) implantation compared to TAVI (OR 0.33, 95% CI: 0.24–0.45) and a 63% reduction compared to SL-AVR (OR 0.37, 95% CI: 0.22–0.61). There were no differences in 30-day mortality or postoperative stroke between the groups. Conclusions: In selected patients, minimally invasive surgical interventions including TAVI and SL-AVR for severe AS are viable alternatives to conventional surgery. However, TAVI is associated with increased paravalvular regurgitation, whereas TAVI and SL-AVR are associated with increased conduction disturbances compared to CAVR. UR - https://jtd.amegroups.org/article/view/26030