The Egyptian Journal of Neurology, Psychiatry and Neurosurgery (Oct 2024)

Ischemic stroke incidence in intermediate or high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement: a comparative systematic review and meta-analysis

  • Shahzaib Rehman,
  • Mahrukh Ghani,
  • Anshahrah Riaz,
  • Syeda Sadia Masood Raza,
  • Mariam Zahid,
  • Muhammad Hammad Zahid Malik,
  • Arman Amir,
  • Ethuri Lokesh,
  • Kovvuru Ashrita,
  • Meet Popatbhai Kachhadia,
  • Vikash Kumar Karmani

DOI
https://doi.org/10.1186/s41983-024-00899-5
Journal volume & issue
Vol. 60, no. 1
pp. 1 – 11

Abstract

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Abstract Background and purpose This comparative systematic review and meta-analysis investigated the incidence of ischemic stroke in intermediate-to-high-risk patients undergoing transcatheter aortic valve replacement versus surgical aortic valve replacement. Methods We conducted a systematic review and meta-analysis following the PRISMA guidelines, searching PubMed, Google Scholar, Embase, Web of Science, and Cochrane CENTRAL databases from their inception to December 2023. The evaluated outcomes were primarily incidence of stroke and transient ischemic attack (TIA), along with other secondary safety end-points at 30 days and 1 year post-procedure. Odds ratios (ORs) with 95% confidence intervals (CIs) were utilized for each study, employing a random-effects model for data synthesis irrespective of heterogeneity. Statistical heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager. Results We screened 8028 articles and included 8 studies consisting of 5 randomized controlled trials and 3 observational studies. The studies examining 30-day and 1-year stroke incidence found no significant difference between TAVR and SAVR patients (OR 0.83, 95% CI 0.59 to 1.17, p = 0.30, OR 0.92, 95% CI 0.64 to 1.33, p = 0.67, respectively). Both TAVR and SAVR also had a comparable risk of having a transient ischemic attack within 30 days (OR 0.93, 95% CI 0.24 to 3.63, p = 0.92, I2 52%) and 1 year (OR 1.15, 95% CI 0.72 to 1.82, p = 0.56, I2 0%) following the procedure. Regarding safety endpoints, TAVR had lower rates of all-cause mortality and acute kidney injury at 1 year post-procedure, but a higher incidence of major vascular complications at both 30 days and 1 year compared with SAVR. Conclusion The results suggest that TAVR and SAVR have comparable outcomes for both TIA and stroke incidence at 30 days and 1 year post-procedure, but display varying safety profiles in intermediate-to-high surgical risk patients.

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