Safety and Efficacy of Transcatheter Aortic Valve Implantation at Centres With Versus Without On-Site Cardiac Surgery: A Systematic Review and Meta-Analysis.
Abdelrahman M Elettreby, Omnia Samy El-Sayed, Nour Eddin M Al-Hawari et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the safety and efficacy of transcatheter aortic valve implantation (TAVI) at centres with versus without on-site cardiac surgery, involving 6 observational cohort studies with 6,109 patients. The analysis found no statistically significant differences in in-hospital mortality (RR=0.94) or 30-day mortality (RR=0.87) between the two settings.
Key findings
- In-hospital mortality was 0.94 in centres with on-site surgery compared to those without.
- 30-day mortality rates were 0.87 for TAVI performed without on-site cardiac surgery.
- Emergent conversion to open-heart surgery was lower at centres without on-site surgery (RR=0.78).
- In-hospital mortality for patients needing emergent surgery after complications was high in both settings (50% vs 62.5%).
Why it matters
Understanding the outcomes of TAVI in different settings is crucial for clinicians in making informed decisions about patient management and institutional protocols, especially regarding the necessity of on-site surgical backup.
What to keep in mind
The certainty of evidence was low to very low, and findings may be affected by residual confounding and publication bias.