Date of Award

2018

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

Objective: The objective of this selective EBM was to investigate the question, “Is the transcatheter aortic valve replacement associated with a decreased mortality rate when compared to the surgical aortic valve replacement method in patients with severe aortic stenosis?”

Study Design: systematic review of 3 English language primary studies, published between 2013 and 2015.

Data Sources: Three Randomized Controlled Trials (RCT’s) published on or after 2010 were selected based on their relevance to the proposed questions via PubMed. All three RCT’s compared transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis.

Outcomes Measured: The outcomes measured in these studies include death from any cause at 1 year, quality of life, physical and social limitations, improvement of left ventricular ejection fraction (LVEF) at 1 year following the procedure, and effect of LVEF on the outcome of the procedure. This was accomplished using three separate techniques depending on the study using either a chi-squared test, fischer exact test, or a combination of both tests.

Results: Thyregod et. al. found that the composite death rate from any cause, stroke or MI at 1 year was similar between TAVR vs. SAVR (13.1% vs 16.3%, repectively; p=0.43). Arnold et. al. demonstrated that at 1 year the rates of favorable outcomes, as defined by this study, did not differ significantly between TAVR vs. SAVR (58% vs 51%; p=0.143). Elmariah et. al. found similar outcomes, death from any cause, stroke, or MI, were observed between TAVR and SAVR in patients who had LVEF < 50% and those with a LVEF of >50% at 1 year (TAVR with LVEF <50% vs LVEF > 50%: 25.9% vs 22.9%, p= 0.56; SAVR with LVEF < 50% vs LVEF > 50% 23.3% vs 25.2%, p=0.79). This study also observed similar outcomes between TAVR with LVEF of < 50% and SAVR with LVEF < 50% at 2 years following the procedure (36.2% vs 31.3%, p=0.826)

Conclusions: Based on these studies, there is no significant decrease in the rate of overall mortality, improvement of LVEF, or improvement of quality of life and symptoms between patients who received TAVR vs SAVR. Further research should be conducted investigating the long term follow up of these procedures to determine appropriate rates of mortality and improvement of symptoms following these procedures.

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