TAVR vs. SAVR outcomes in patients with previous mediastinal irradiation

TrialKey findings
Elbadawi et al. [46] (2020)TAVR was associated with lower in-hospital mortality (1.2% vs. 2.0%), lower rates of acute kidney injury, bleeding, respiratory complications, and shorter hospital stays relative to SAVR. However, TAVR was associated with higher rates of pacemaker insertion.
Yazdchi et al. [47] (2021)SAVR had an operative mortality of 4.3% compared to 1.4% for TAVR. SAVR patients also had longer intensive care unit (ICU) duration and higher blood transfusion requirements. Both cohorts had similar rates of stroke and pacemaker implantation.
Nauffal et al. [48] (2021)TAVR was associated with lower rates of postoperative atrial fibrillation, pneumonia, pleural effusion, renal failure, and bleeding compared to SAVR. Stroke/transient ischemic attack and pacemaker implantation were higher with TAVR. Thirty-day mortality, cardiovascular mortality, and hospital readmission in the TAVR group were 4.6%, 1.7%, and 10.9% compared with 3.6%, 1.6%, and 11.2% in the SAVR group, respectively.
Jørgensen et al. [56] (2021)At the 8-year follow-up mark, the estimated composite outcome risk of all-cause mortality, stroke, or myocardial infarction (MI) was insignificant between TAVR and SAVR (54.5% vs. 54.8%).
Kodali et al. [57] (2012)TAVR and SAVR had similar outcomes pertaining to mortality, symptom reduction, and improved valve hemodynamics. However, paravalvular regurgitation was more frequent after TAVR and was associated with increased mortality later.
Leon et al. [58] (2016)TAVR resulted in larger aortic-valve areas than SAVR along with lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation. However, SAVR resulted in fewer major vascular complications and less paravalvular aortic regurgitation.