Why the study?
TAVR is increasingly considered an alternative to SAVR for low-risk patients with aortic stenosis, but its long-term efficacy remains uncertain.
Does TAVR improve clinical outcomes compared to SAVR in low surgical risk patients with aortic stenosis?
Meta-Analysis (n=4,532)
Does TAVR improve clinical outcomes compared to SAVR in low surgical risk patients with aortic stenosis?
Answers are grounded in this paper and cite their sources.
TAVR provides early mortality and bleeding benefits over SAVR in low-risk aortic stenosis patients, but long-term outcomes at 5 or more years remain uncertain.
Transcatheter aortic valve replacement (TAVR) is increasingly considered as an alternative to surgical aortic valve replacement (SAVR) for low-risk patients with aortic stenosis. However, its long-term efficacy remains uncertain. To compare clinical outcomes and procedural complications of TAVR versus SAVR in low-risk patients with aortic stenosis. We updated our 2019 systematic review by searching MEDLINE, EMBASE, and Cochrane Central (May 2019-April 2025) for randomized controlled trials (RCTs) comparing TAVR and SAVR in low-risk patients with aortic stenosis. We extracted outcomes at 30 days, 12 months, and ≥5 year follow-up. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 tool. Five RCTs (n = 4,532) were included. TAVR reduced 30-day all-cause mortality (RR: 0.45, 95% CI: 0.37-0.55), cardiovascular mortality (RR: 0.45, 95% CI: 0.38-0.54), atrial fibrillation (RR: 0.21, 95% CI: 0.10-0.41), and life-threatening bleeding (RR: 0.28, 95% CI: 0.13-0.58), but increased pacemaker implantation (RR: 3.10, 95% CI: 1.23-7.82). Mortality benefits persisted at 12 months. At ≥5 years, results were inconclusive due to wide CIs across outcomes, including all-cause death (RR: 0.99, 95% CI: 0.72-1.35), cardiovascular death (RR: 0.93, 95% CI: 0.64-1.35), atrial fibrillation (RR: 0.44, 95% CI: 0.16-1.22), endocarditis (RR: 0.70, 95% CI: 0.33-1.45) and aortic reintervention (RR: 1.21, 95% CI: 0.59-2.49). TAVR shows early clinical benefits in low-risk patients with aortic stenosis, but long-term outcomes compared to SAVR remain uncertain. Individualized heart team decision-making remains essential.
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Jarade et al. (2026) conducted a meta-analysis in aortic stenosis (n=4,532). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day all-cause mortality (RR 0.45, 95% CI 0.37-0.55).
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