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

Q: What are the key findings of this study?

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).

Q: 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).

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.

Karam Khasawneh; Mohamed Alzandani; Ghaeth Khasawneh; John Obeid; Christopher Bobier

doi:10.7759/cureus.104196

February 24, 2026CureusOpen Access

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

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Key result

TAVR shows similar long-term all-cause mortality to SAVR in low-risk patients.

HR 1.03
95% CI 0.95-1.11
P=0.54

Figures

Why the study?

Uncertainty remains regarding the long-term outcomes of TAVR compared with SAVR in low-risk populations with aortic stenosis.

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?

Key Points

To evaluate long-term mortality, stroke, postoperative complications, and valve durability between transcatheter and surgical aortic valve replacement in low-risk patients with aortic stenosis.
Systematic review analyzing randomized controlled trials, observational cohorts, registry-based analyses, and pooled meta-analyses across multinational clinical and administrative settings.
Assessed endpoints spanning in-hospital recovery to long-term follow-up across differing study designs and valve generations.
Study evidence demonstrated parallel long-term survival and stroke rates between transcatheter and surgical procedures, whereas observational cohorts showed higher late mortality for transcatheter replacement in patients <65 years of age.
Transcatheter replacement led to fewer postoperative complications, including reduced rates of acute kidney injury, new-onset atrial fibrillation, and less need for circulatory support in patients <60 years of age.
Durability and repeat intervention patterns diverged across studies, with transcatheter valves showing earlier re-interventions while surgical re-operations carried increased risk in aging patients.

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?

P

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).

I

Intervention

Transcatheter aortic valve replacement (TAVR)

C

Comparator

Surgical aortic valve replacement (SAVR)

O

Outcome

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

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

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.

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
Heterogeneity in study design, population selection, valve generation, and follow-up duration
Observational data are subject to residual confounding despite matching strategies
Rapid evolution of TAVR technology means that long-term outcomes derived from earlier devices may not fully represent current performance

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports TAVR as SAVR alternative in low-risk AS; reinforces randomized evidence but leaves late outcomes open from observational data in younger patients.

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.

Cite This Study

Khasawneh et al. (2026) conducted a systematic review in Low-risk patients with aortic stenosis undergoing aortic valve replacement. Transcatheter Aortic Valve Replacement (TAVR) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on All-cause mortality (HR 1.03, 95% CI 0.95-1.11, p=0.54). 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).

synapsesocial.com/papers/699fe3af95ddcd3a253e7b39 https://doi.org/10.7759/cureus.104196

Topics

TAVR in low-risk patients

Transcatheter aortic valve replacement

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

Topics

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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