Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis and Prior Mediastinal Radiation: A Meta-Analysis of Short-Term and 1-Year Outcomes

Mediastinal radiation potentiates aortic stenosis and complicates its treatment. We compared the short and midterm-outcomes with transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients with prior mediastinal radiation. Electronic databases were searched from inception through December 2024. Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes were pooled as mean differences (MDs) with respective 95% confidence intervals (CIs). Six observational studies were identified, including 2458 TAVR patients and 1873 SAVR patients. In the short-term, TAVR was associated with lower rate of mortality (RR: 0.54; 95% CI: 0.34-0.88), atrial fibrillation (RR: 0.31; 95% CI: 0.15-0.65), acute kidney injury (RR: 0.75; 95% CI: 0.59-0.95), bleeding (RR: 0.37, 95% CI: 0.33-0.42), and shorter length of hospital stay (MD: -4.30; 95% CI: -5.45 to -3.15). One-year mortality was comparable between the 2 groups (RR: 1.04; 95% CI: 0.50-2.13). This meta-analysis of observational studies of patients with prior mediastinal radiation demonstrated that TAVR was associated with better short-term outcomes compared to SAVR. While 1-year mortality appeared similar between the 2 interventions, this finding should be interpreted with caution. However, randomized controlled trials are needed to validate these findings.