Key result
TAVR cuts 1-year mortality ~40% vs SAVR in low-risk patients but shows no 5-year difference.
Why the study?
TAVR is increasingly used in patients with AS at low risk for SAVR, despite uncertainty regarding medium- and long-term clinical outcomes.
Does transcatheter aortic valve replacement reduce mortality, rehospitalization, or stroke in low-risk patients with aortic valve stenosis compared to surgical aortic valve replacement?
Meta-Analysis (n=4,487)
Does transcatheter aortic valve replacement reduce mortality, rehospitalization, or stroke in low-risk patients with aortic valve stenosis compared to surgical aortic valve replacement?
In low-risk patients with aortic stenosis, TAVR reduces 1-year all-cause mortality and rehospitalization compared to SAVR, though this survival benefit is attenuated by 5 years.
Answers are grounded in this paper and cite their sources.
Supports TAVR for 1-year mortality reduction in low-risk aortic stenosis; confirms early benefit but leaves long-term equivalence open.
Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes. Objectives: We performed an updated meta-analysis comparing TAVR with SAVR in this population. Methods: We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up. Results: We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30-1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41-0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81-1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46-0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53-0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48-1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48-1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81-1.46; p = 0.56) were not significantly different. Conclusions: TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.
No takes yet. Share an insight, caveat, or question.
Meeus et al. (2025) conducted a meta-analysis in aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (n=4,487). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on 1-year all-cause mortality (RR 0.60, 95% CI 0.41-0.98, p=0.01). TAVR in low-risk patients with aortic stenosis significantly reduced 1-year all-cause mortality compared with SAVR (RR 0.60; 95% CI 0.41-0.98; p=0.01), but no difference was seen at 5 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: