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Tesi etd-10022019-105520

Type of thesis
Master univ. II liv.
Author
OTTANI, FILIPPO
E-mail address
ottanif@alice.it
URN
etd-10022019-105520
Title
Transcatheter aortic valve implantantion versus surgical replacement for treatment of symptomatic severe aortic stenosis: an intermediate low-risk clinical case and a review and meta-analysis of the available clinical trials
Course
Percutaneous interventional treatment of structural heart diseases
Committee
relatore Dott. OTTANI, FILIPPO
Tutor Dott. BERTI, SERGIO
Relatore Prof. PASSINO, CLAUDIO
Keywords
  • Aortic stenosis
  • Cardiac surgery
  • Transcatheter aortic valve replacement
Exam session start date
08/10/2019;
Availability
completa
Abstract
Since new evidence fron randomized clinical trials (RCTs) in low-risk patents with severe aortic stenosis has become available, we compared the efficacy and safety of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients. Seven RCTs were identified. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria.The primary outcome was &#34;all-cause&#34;mortality up to 2 years for the main analysis. Overall 8020 patients were included, 4014 randomized to TAVI and 4006 to SAVR.Irrespective of the basal surgical risk, TAVI was associated with a significant reduction of all-cause mortality (Risk Difference -0.01, 95% CI: -0.02-0.00; p=.04). The overall resul was mainly driven by the reduction of all-cause and cardiovascular mortality in the low-risk population. Surgical aortic valve replacement was, however, associated with a loer risk of major vascuar complications and permanent pacemaker implantations.<br>Compared to SAVR, TAVI is associetd with reduction in all-cause mortality and this is particularly evident among low-risk patient subgroup.
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