Abstract

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: In low-risk patients aged >70–75 with severe aortic stenosis, is transcatheter superior to surgical aortic valve replacement in terms of reported composite outcomes and survival? More than 73 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The only low-risk randomized control trial to date [Nordic Aortic Valve Intervention (NOTION)] regarding an elderly population did not show a statistically significant difference between the 2 approaches regarding the composite endpoint of death, stroke or myocardial infarction. A subgroup analysis of elderly patients in the 2 main low-risk randomized control trials did not yield statistically different results from those of the overall population; the results indicated the superiority of transcatheter aortic valve implantation regarding the composite of death, stroke or rehospitalization at 1 year [The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis (PARTNER 3)] and non-inferiority regarding a composite of death or stroke at 2 years [Medtronic Evolut Transcatheter Aortic Valve Replacement in Low-Risk Patients (Evolut LR)]. The results from lower evidence studies are largely consistent with these findings. Overall, there is no compelling evidence indicating that older age should be an isolated criterion for the choice between transcatheter aortic valve replacement and surgical aortic valve replacement in otherwise low-risk patients. The superiority of either technique regarding the aforementioned composite short-term outcomes in this particular subgroup of patients is unclear.

中文翻译：

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对于年龄 > 70-75 岁的严重主动脉瓣狭窄的低风险患者，在报告的心血管复合结局和生存率方面，经导管是否优于外科主动脉瓣置换术？

摘要

心脏手术的最佳证据主题是根据结构化方案编写的。解决的问题是：在年龄>70-75 岁的严重主动脉瓣狭窄的低风险患者中，就报告的复合结局和生存率而言，经导管是否优于外科主动脉瓣置换术？使用报告的搜索找到了超过 73 篇论文，其中 8 篇代表了回答临床问题的最佳证据。将这些论文的作者、期刊、出版日期和国家、研究的患者组、研究类型、相关结果和结果制成表格。迄今为止，唯一一项针对老年人群的低风险随机对照试验 [北欧主动脉瓣干预 (NOTION)] 并未显示两种方法在死亡复合终点方面存在统计学显着差异，中风或心肌梗塞。在 2 项主要的低风险随机对照试验中，对老年患者的亚组分析与总体人群的结果没有统计学差异；结果表明，经导管主动脉瓣植入术在 1 年死亡、中风或再住院的复合方面具有优势[SAPIEN 3 经导管心脏瓣膜在低风险主动脉瓣狭窄患者中的安全性和有效性 (PARTNER 3)] 和非劣效性关于 2 年时死亡或中风的复合情况 [Medtronic Evolut 经导管主动脉瓣置换术在低风险患者中的应用 (Evolut LR)]。低证据研究的结果与这些发现基本一致。全面的，没有令人信服的证据表明年龄应该是在其他低风险患者中选择经导管主动脉瓣置换术和外科主动脉瓣置换术之间的孤立标准。对于上述特定患者亚组的上述复合短期结果，这两种技术的优势尚不清楚。