ABSTRACT
This umbrella meta-analysis aims to investigate two surgical treatments for abdominal aortic aneurysm (AAA): endovascular aneurysm repair (EVAR) and open surgery repair (OSR). Our study aims to elucidate the 30-day mortality rate, reintervention rates, and aneurysm-related mortality in EVAR versus OSR for AAA. We conducted a comprehensive assessment of meta-analyses (n = 34 articles) comparing EVAR and OSR for AAA. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol and considered statistical significance at P ≤ 0.05. For the 30-day mortality rate, a pooled odds ratio (pOR) of 0.59 (95% confidence interval [CI] 0.45-0.77, P = 0.0001, and I2 = 98%) indicates that EVAR was associated with a lower risk of mortality compared to OSR. For reintervention rates, a pOR of 1.33 (95% CI = 0.98-1.82, P = 0.11, and I2 = 90%). In aneurysm-related mortality, a pOR of 0.78 (95% CI = 0.63-0.97, P = 0.03, and I2 = 43%). In postoperative rupture of aneurysm, a pOR of 3.28 (95% CI = 2.16-4.98, P < 0.00001, and I2 = 50%). Furthermore, when analyzing systemic complications, only for visceral ischemia, significant results showed lower odds for EVAR, with a pOR of 0.57 (95% CI = 0.40-0.80, P = 0.001, and I2 = 0%) was found. EVAR is better in terms of short-term mortality rate and aneurysm-related mortality. Furthermore, EVAR is still a safer procedure in elective settings, as the studies we included recruited patients for this setting. However, given the high reintervention rates and recent developments in surgical techniques and materials, more recent data and extensive research are needed.
ABSTRACT
Prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement using either a transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). This study aims to review the profiles and outcomes of PVE after surgical versus transcatheter aortic valve replacement. Electronic searches were performed on Scopus, EMBASE, and PubMed to retrieve related articles. To be included, study designs had to be randomized controlled trials (RCT) or observational cohort studies (in English) with PVE patients that compared differences based on TAVI or SAVR. This review included data for 13,221 patients with PVE diagnoses. Of those, 2,109 patients had an initial SAVR, and 11,112 patients had an initial TAVI. There was no difference in the incidence of PVE in patients who had initial TAVI versus SAVR (1.05% versus 1.01% per person-year, p=0.98). However, the onset of early PVE was more frequently observed in the TAVI group (risk ratio (RR): 1.54, 95% confidence interval (CI) [1.14, 2.08], p=0.005). Patients in the TAVI group had a lower indication for surgery to treat PVE when compared to SAVR (RR: 0.55, 95%CI [0.44, 0.69], p<0.001). Staphylococcus aureus was more likely to be the source of PVE in patients who had previous TAVI (RR: 1.34, 95%CI [1.17, 1.54], p<0.001). Also, Enterococcus faecalis was more frequently observed as a cause of PVE in the TAVI group (RR: 1.49, 95%CI [1.21, 1.82], p<0.001). Patients who underwent SAVR and TAVI had similar incidences of PVE. However, patients who underwent SAVR had a greater indication for surgery to treat PVE, while those who underwent TAVI had higher comorbidities, a higher likelihood of early PVE, and a trend towards higher one-year mortality.