Key result
TAVR matches SAVR for five-year mortality but shows lower mortality at six months.
Why the study?
Long-term mortality benefits following aortic valve replacement, particularly when comparing TAVR with SAVR, remained uncertain.
Does transcatheter or surgical aortic valve replacement reduce all-cause mortality in patients with severe aortic stenosis compared to conservative management?
Meta-Analysis (n=34,643)
Yes
Does transcatheter or surgical aortic valve replacement reduce all-cause mortality in patients with severe aortic stenosis compared to conservative management?
Absolute Event Rate: 34% vs 34.2%
p-value: p=0.262
TAVR and SAVR provide comparable 5-year survival in severe aortic stenosis across surgical risk categories, both significantly improving survival compared to conservative management.
TAVR's early mortality benefit with five-year equivalence to SAVR supports individualized selection; confirms long-term parity across risk strata.
For Aortic valve replacement (AVR), both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) serve as a pivotal therapeutic approach for severe aortic stenosis (AS). While both modalities show advantages over conservative management, the long-term mortality benefits post AVR, especially when comparing TAVR with SAVR, remain uncertain. A comprehensive meta-analysis was conducted through a systematic search of electronic databases up to December 7, 2023. Individual patient data extracted from Kaplan-Meier plots underwent pooling and modeling with stratification by surgical risk. The primary endpoint was all-cause mortality at five years. The study included 11 randomized controlled trials (RCTs) and 12 non-RCTs, encompassing 4,215 patients undergoing TAVR, 4,017 undergoing SAVR, and comparing 11,285 AVR patients with 23,358 receiving conservative management. Transcatheter aortic valve replacement exhibited significantly lower all-cause mortality at six months (hazard ratio (HR) 0.62, 95% CI: 0.52-0.74) compared to SAVR, with no significant difference beyond 6 months (HR 1.08, 95% CI: 0.98-1.19). There were no significant differences in cardiovascular mortality (HR 0.98, 95% CI: 0.83-1.16), stroke (HR 1.02, 95% CI: 0.75-1.38), or valvular hemodynamics between TAVR and SAVR. Aortic valve replacement markedly reduced all-cause mortality compared to medical therapy (P < 0.001), with five-year crude mortality rates of 31.6% versus 49.3% and a difference in restricted mean survival time of 8.9 months. Similar outcomes were observed across high, intermediate, and low surgical risk categories. While TAVR demonstrated early mortality reduction compared to SAVR, no distinctions emerged in the overall five-year follow-up, regardless of surgical risk. Aortic valve replacement notably improved survival over conservative therapy. This study advocates for the preference of TAVR or SAVR in severe AS patients when feasible.
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Ma et al. (2024) conducted a meta-analysis in Severe Aortic Stenosis (n=34,643). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on All-cause mortality at five years (p=0.262). Transcatheter aortic valve replacement demonstrated comparable five-year all-cause mortality to surgical replacement (34.0% vs 34.2%), though it exhibited significantly lower mortality at six months.
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