Temporal Trends in Mortality after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Regression Analysis

Background: We estimated trends for mortality after transcatheter aortic valve replacement (TAVR) using meta-analytic techniques. Mortality rates after TAVR have reportedly declined as the procedure became more routinized and device technology improved. Confirming this finding with a systematic assessment of the evidence could have substantial implications for the choice between TAVR and surgical valve replacements. Methods: We conducted a systematic literature review up to June 20, 2018 and extracted data on 30-day and 1-year mortality rates, surgical risk, device type, study design, and the proportion of procedures that used a transapical approach. We used meta-regression to test whether risk-adjusted 30-day and 1-year mortality rates declined over time. Results: We identified 145 studies and 179 subsamples, once results for separately reported subgroups were broken out. Of these, 160 subsamples (89%) representing 137 studies and 91,652 patients contained information on 30-day mortality, and 93 subsamples (52%) representing 84 studies and 40,765 patients information on 1-year mortality. The adjusted 30-day mortality rate after TAVR fell from 10.48% (95% CI 7.97-11.65%) in 2007 to 2.27% (95% CI 1.14-4.49%) in 2016, corresponding to a relative decrease of 78% over 10 years. The adjusted mortality rate within 1 year after TAVR was 30.24% (95% CI 24.53-36.65%) in 2007 and fell to 11.35% (95% CI 8.32-15.31%) in 2014, corresponding to a relative decrease of 63% over 8 years. Conclusions: The results suggest that near-term survival after TAVR has improved substantially within the short period after the procedure was introduced and support the increasing utilization of TAVR.