Unlocking the Evolving Landscape of TAVR in Aortic Valve Replacement: A Comprehensive Systematic Review

Abstract

Objective: Advancements in Transcatheter Aortic Valve Replacement (TAVR) have transformed the management of aortic valve disease, offering a less invasive alternative to Surgical Aortic Valve Replacement (SAVR). This review summarizes the current literature on TAVR, focusing on technological innovations, procedural outcomes, and comparative effectiveness compared to SAVR. Methodology: We conducted a systematic search of electronic literature on the TAVR across databases including Medline, PubMed, Google Scholar, and PsycINFO up to April 2024. Studies were selected based on predefined PICO criteria. A total of 324 studies were identified, and after applying inclusion/exclusion criteria, 96 studies were selected for review. Data was extracted using Rayyan software, focusing on study characteristics, patient demographics, aortic valve replacement methodologies, intervention details, and key findings. Statistical analysis of efficacy was performed using SPSS. Only English-language studies were included, with disagreements resolved through consensus among team members. Results: The primary areas of focus demonstrate comparable rates of mortality and procedural complications to SAVR but with a notable reduction in cases of stroke and acute kidney injury. Long-term data from trials such as PARTNER-1 and registry analyses indicate a favorable mid-term durability of TAVR valves, particularly in older patients. However, caution is advised in younger patients with bicuspid aortic valves due to limited long-term data. The efficacy of TAVR in aortic valve disease is summarized in Table 1. Conclusion: TAVR heralds a paradigm shift in aortic valve replacement, offering promising outcomes comparable to SAVR with additional benefits in specific patient cohorts. The importance of continued research cannot be overstated, as it is crucial to refine patient selection criteria, optimize procedural techniques, and further evaluate the long-term durability and cost-effectiveness of TAVR in diverse clinical settings.