Abstract
IntroductionNonagenarians i.e. age > 90 are usually not considered for surgical aortic valve replacement (SAVR) owing to their increased surgical risk. This patient population is also under represented in clinical trials that have evaluated the role of trans-catheter aortic valve replacement (TAVR) for severe aortic stenosis.So the effectiveness of TAVR as compared to SAVR remains unknown.ObjectiveTo compare safety and effectiveness of TAVR versus SAVR in nonagenarians.MethodsLiterature search was performed using PubMed, Embase, Web of science, Cochrane library and clinicaltrials.gov. Databases were systematically searched up to 5-21-2019. Primary end point was 30-day mortality. Secondary end points were post-operative incidences of stroke or transient ischemic attacks, vascular access related complications, acute renal failure, transfusion requirement, length of hospital stay, respectively.The main summary estimate was random effects Risk ratio(RR) with 95% confidence intervals (CIs).ResultsFour retrospective studies were included (N= 8389). TAVR was performed in 3112 patients while 5277 patients underwent SAVR. Our study found no difference in 30-days mortality between TAVR and SAVR [RR = 0.91 (0.76 - 1.10), p= 0.318]. TAVR was associated with a significantly reduced risk of post-operative ARF [RR = 0.72 (0.62 - 0.83), p<0.001] and a lower transfusion requirement [RR = 0.71 (0.62 - 0.81), p < 0.001], respectively. There was no difference in risk of stroke/TIA between two groups [RR = 1.01 (0.70 - 1.45), p= 0.957] and risk of vascular access complications was significantly higher with TAVR [RR = 3.39 (2.65 - 4.333), p<0.001].On an average, Length of hospital stay was 3 days less in patients undergoing TAVR (p= 0.037).ConclusionTAVR was not shown to have an increased risk of short term mortality or stroke along with a better post-operative outcomes when weighed against SAVR in nonagenarians.