What question did this study set out to answer?

To compare the outcomes of transcatheter and surgical aortic valve replacement versus conservative management in asymptomatic aortic stenosis.

January 10, 2026Interdisciplinary CardioVascular and Thoracic SurgeryOpen Access

Surgical vs transcatheter aortic valve replacement for asymptomatic severe aortic stenosis- an updated meta-analysis of reconstructed individual patient data

Q: What are the key findings of this study?

Aortic valve replacement (AVR) significantly reduced all-cause mortality by 57% compared to conservative management in asymptomatic aortic stenosis patients (IRR = 0.43).

Q: What does this research mean for the field?

Aortic valve replacement (AVR) significantly reduces all-cause mortality by 57% compared to conservative management in asymptomatic aortic stenosis patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

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Key result

AVR cuts all-cause mortality ~57% vs conservative management in asymptomatic AS patients.

Why the study?

The optimal management of asymptomatic aortic stenosis remains controversial.

Does transcatheter or surgical aortic valve replacement reduce mortality in patients with asymptomatic severe aortic stenosis compared to conservative management?

Key Points

To compare the outcomes of transcatheter and surgical aortic valve replacement versus conservative management in asymptomatic aortic stenosis.
Systematic search of PubMed/MEDLINE, Web of Science, Scopus, and Cochrane CENTRAL until September 2025.
Inclusion of observational and randomized controlled studies that meet specified criteria.
Primary outcomes included short and long-term mortality and heart failure hospitalization rates.
Data meta-analysis employed incidence rate ratios derived from Kaplan-Meier curves.
AVR was associated with a significantly lower risk of all-cause mortality (IRR = 0.43; p < 0.001).
Cardiovascular mortality reduced with AVR (IRR = 0.47; p < 0.01).
Markedly lower risk of heart failure hospitalization for AVR recipients (IRR = 0.39; p < 0.01).
Substantial reduction in sudden cardiac death (IRR = 0.13; p < 0.01) and myocardial infarction (IRR = 0.11; p = 0.03).
No significant difference in stroke risk (IRR = 0.77; p = 0.07).

Structured PICO

Does transcatheter or surgical aortic valve replacement reduce mortality in patients with asymptomatic severe aortic stenosis compared to conservative management?

Population

Patients with asymptomatic severe aortic stenosis from 17 observational or randomized controlled studies

Intervention

Transcatheter or surgical aortic valve replacement (TAVR or SAVR)

Comparator

Conservative management

Outcome

Short cardiovascular and non-cardiovascular mortality as well as long-term mortalityhard clinical

Aortic valve replacement (TAVR or SAVR) is associated with significantly lower short- and long-term mortality compared to conservative management in patients with asymptomatic severe aortic stenosis.

Implication

May support AVR evaluation in asymptomatic severe AS; leaves open confirmation by dedicated RCTs before practice change.

Abstract

OBJECTIVES The management of asymptomatic aortic stenosis (AS) is controversial. We perform a meta-analysis of reconstructed individual patient data to compare conservative treatment versus transcatheter or surgical aortic valve replacement (TAVR or SAVR) in asymptomatic AS. METHODS PubMed/MEDLINE, Web of Science, Scopus, and Cochrane CENTRAL were systematically searched, through 25th September 2025, to identify any observational or randomized controlled studies that comply with our inclusion criteria. Our primary outcomes were short cardiovascular and non-cardiovascular mortality as well as long-term mortality. We combined aggregate data meta-analysis for dichotomous outcomes using incidence rate ratio (IRR) with reconstructed time-to-event data derived from published Kaplan–Meier curves using validated algorithms. RESULTS Seventeen studies were included. Overall, AVR was associated with a significantly lower risk of all-cause mortality compared with conservative management (IRR = 0.43; 95% CI, 0.32–0.57; p < 0.001). Cardiovascular mortality was also significantly reduced with AVR (IRR = 0.47; 95% CI, 0.29–0.75; p < 0.01; I2 = 62%). The risk of heart failure hospitalization was markedly lower among AVR recipients (IRR = 0.39; 95% CI, 0.22–0.67; p < 0.01), with consistent benefit across study designs. AVR was further associated with a substantial reduction in sudden cardiac death (IRR = 0.13; 95% CI, 0.04–0.48; p < 0.01) and myocardial infarction (IRR = 0.11; 95% CI, 0.04–0.31; p = 0.03). The risk of stroke was not significantly different between groups (IRR = 0.77; 95% CI, 0.58–1.02; p = 0.07). Reconstructed Kaplan–Meier analyses demonstrated durable long-term survival benefit with AVR, consistent across surgical and transcatheter approaches CONCLUSIONS Patients with asymptomatic AS, managed with either SAVR or TAVR, were associated with lower short- and long-term mortality compared to conservative management.

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Published by Interdisciplinary CardioVascular and Thoracic Surgery · CC BY

Cite This Study

Awad et al. (2025) studied this question. Aortic valve replacement (AVR) significantly reduced all-cause mortality by 57% compared to conservative management in asymptomatic aortic stenosis patients (IRR = 0.43).

synapsesocial.com/papers/6963222f91e05aa366cb8c04 https://doi.org/10.1093/icvts/ivaf308