What is the clinical evidence from this study?

Study design: Systematic Review. Population: Low-risk patients with aortic stenosis undergoing aortic valve replacement. Intervention: Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR). Primary outcome: All-cause mortality (HR 1.03, 95% CI 0.95-1.11, p=0.54).

What question did this study set out to answer?

This review aims to assess long-term outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients.

February 26, 2026Cureus0 citationsOpen Access

Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: A Systematic Review of Long-Term Outcomes

Q: What does this research mean for the field?

Transcatheter aortic valve replacement demonstrates similar long-term all-cause mortality compared to surgical aortic valve replacement in low-risk patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

KKKaram KhasawnehCentral Michigan University MAMohamed AlzandaniUniversity of Minnesota GKGhaeth KhasawnehUniversity of Minnesota

Key Result

Transcatheter aortic valve replacement demonstrated similar long-term all-cause mortality compared to surgical aortic valve replacement in low-risk patients (HR 1.03; 95% CI 0.95-1.11; p=0.54).

Key Points

This review aims to assess long-term outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients.
Conducted a systematic review of randomized and observational studies
Evaluated long-term mortality, stroke rates, and postoperative complications
Analyzed valve durability and re-intervention rates across studies
Similar long-term survival and stroke rates found between TAVR and SAVR in randomized data
Observational studies indicated worse late outcomes following TAVR
Fewer postoperative complications associated with TAVR
Durability and re-intervention outcomes varied significantly across studies

Study Design

Type

Systematic Review

Multicenter

Yes

Structured PICO

Does transcatheter aortic valve replacement improve long-term mortality, stroke, postoperative complications, and valve durability in low-risk patients with aortic stenosis compared to surgical aortic valve replacement?

Population

Low-risk patients with aortic stenosis (defined most commonly as STS-PROM score <4%, preserved functional status, and absence of major surgical contraindications). 11 articles included (RCTs, observational cohorts, registry-based analyses, and pooled meta-analyses).

Intervention

Transcatheter aortic valve replacement (TAVR)

Comparator

Surgical aortic valve replacement (SAVR)

Outcome

Long-term all-cause mortality, stroke, postoperative complications, and valve durabilityhard clinical

TAVR is an effective alternative to SAVR in appropriately selected low-risk populations with comparable long-term survival and stroke outcomes, though caution is warranted in younger patients where observational data suggest potential worse late outcomes.

Main Result

Effect estimate: HR 1.03 (95% CI 0.95-1.11)

Absolute Event Rate: 51.8% vs 52.6%

p-value: p=0.54

Limitations

Heterogeneity in study design, populations, valve generations, and follow-up durations
Observational data subject to residual confounding despite adjustment
Long-term outcomes derived from earlier TAVR devices may not reflect current technology

Abstract

The role of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) continues to expand, yet uncertainty remains regarding the long-term outcomes in low-risk populations compared with surgical aortic valve replacement (SAVR). This systematic review examined long-term mortality, stroke, postoperative complications, and valve durability across randomized and observational studies. Randomized data showed similar long-term survival and stroke rates between TAVR and SAVR, while observational studies suggested worse late outcomes following TAVR. TAVR was consistently associated with fewer postoperative complications, whereas durability and re-intervention findings varied across studies. Overall, these results suggest that while TAVR offers meaningful advantages, treatment decisions should be individualized to balance a patient's comorbidities with long-term procedural outcomes.

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