Fig 1 - uploaded by Dave M Mathew
Content may be subject to copyright.
Forest plot comparing bioprosthetic valve (BV), homograft valve, mechanical valve (MV), Ozaki, and Ross for A 30-day mortality B 30-day stroke C 30-day myocardial infarction D 30-day major bleeding. RR risk ratio
Contexts in source publication
Context 1
... NMA was conducted in accordance with the MetaAnalysis of Observational Studies in Epidemiology (MOOSE) [15] (Additional file 1: Figure 1) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [16] guidelines (Additional file 1: Figure 2). ...
Context 2
... to the Ross procedure, both BV and MV were associated with significantly higher rates of 30-day mortality (BV: RR 2.37, 95% CI 1.20-4.67; MV: 1.88, 95% CI 1.04-3.40). There was no significant difference in 30-day mortality between homograft or Ozaki and the Ross procedure. As shown in the ranking table (Fig. 1A, Additional file 1: Table 7), the Ozaki procedure ranked first in terms of lower mortality risk, followed by homograft and the Ross procedure. No heterogeneity was observed (I 2 = 0%, p = 0.75). Further details about inconsistencies between studies are found in Additional file 1: Figures 3 and ...
Context 3
... to the Ross procedure, only MV was associated with a higher risk of 30-day stroke (RR 8.42, 95% CI 1.57-45.23). Conversely, no difference was seen between BV, homograft, and the Ozaki procedure when compared to the Ross procedure. As shown in the ranking table (Fig. 1B, Additional file 1: Table 8), Ross had the lowest stroke risk followed by BV, homograft, and MV. No heterogeneity was observed (I 2 = 0%, p value = 0.95). Further details about inconsistencies between studies are found in Additional file 1: Figures 3.1 and ...
Context 4
... were no significant differences in 30-day MI between any of the aortic conduits compared to the Ross procedure. According to the ranking table (Fig. 1C, Additional file 1: Table 9), BV had the lowest MI risk, followed by MV, homograft, then the Ross procedure. Low heterogeneity was observed (I 2 = 15%, p = 0.52). Further details about inconsistencies between studies are found in Additional file 1: Figures 3.2 and ...
Context 5
... was associated with a higher risk of 30-day major bleeding when compared to the Ross procedure (RR 4.58, 95% CI 1.94-10.85). Although homograft was associated with a lower risk of major bleeding when compared to the Ross procedure (RR 0.35, 95% CI 0.17-0.71), BV showed no significant difference. According to the ranking table (Fig. 1D, Additional file 1: Table 10), homograft ranked first in terms of lower major bleeding risk, followed by the Ross procedure, BV, and MV. Low heterogeneity was observed (I 2 = 18%, p = ...
Citations
Background:
Transcatheter aortic valve replacement (TAVR) has evolved as an alternative to surgical aortic valve replacement (SAVR). In addition to full-sternotomy (FS), recent reports have shown successful minimally-invasive SAVR approaches, including mini-sternotomy (MS) and mini-thoracotomy (MT). This network-meta-analysis (NMA) seeks to provide an outcomes comparison based on these different modalities (MS, MT, TAVR) compared with FS as a reference arm for the management of aortic valve disease.
Methods:
A comprehensive literature search was performed to identify studies that compared minimally-invasive SAVR (MS/MT) to conventional FS-SAVR, and/or TAVR. Bayesian NMA was performed using the random effects model. Outcomes were pooled as risk ratios (RR) with their 95 % confidence intervals (CIs). Our primary outcomes included 30-day mortality, stroke, acute kidney injury (AKI), major bleeding, new permanent pacemaker (PPM), and paravalvular leak (PVL). We also assessed long-term mortality at the latest follow-up.
Results:
A total of 27,117 patients (56 studies) were included; 10,397 patients had FS SAVR, 9523 had MS, 5487 had MT, and 1710 had TAVR. Compared to FS, MS was associated with statistically-significantly lower rates of 30-day mortality (RR, 0.76, 95%CI 0.59-0.98), stroke (RR, 0.84, 95%CI 0.72-0.97), AKI (RR, 0.76, 95%CI 0.61-0.94), and long-term mortality (RR 0.84, 95%CI 0.72-0.97) at a weighted mean follow-up duration of 10.4 years, while MT showed statistically-significantly higher rates of 30-day PVL (RR, 3.76, 95%CI 1.31-10.85) and major bleeding (RR 1.45; 95%CI 1.08-1.94). TAVR had statistically significant lower rates of 30-day AKI (RR 0.49, 95%CI 0.31-0.77), but showed statistically-significantly higher PPM (RR 2.50; 95%CI 1.60-3.91) and 30-day PVL (RR 12.85, 95%CI 5.05-32.68) compared to FS.
Conclusions:
MS was protective against 30-day mortality, stroke, AKI, and long-term mortality compared to FS; TAVR showed higher rates of 30-day PVL and PPM but was protective against AKI. Conversely, MT showed higher rates of 30-day PVL and major bleeding. With the emergence of TAVR, the appropriate benchmarks for SAVR comparison in future trials should be the minimally-invasive SAVR approaches to provide clinical equipoise.
