June 7, 2026Journal of the American College of Cardiology
Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients
Key result
TAVR cuts 1-year all-cause death ~39% vs SAVR in low-risk severe aortic stenosis.
- RR 0.61
- 95% CI 0.39 to 0.96
- P=0.03
- n=2,887
Why the study?
SAVR remains standard therapy for severe AS in low-risk patients, whereas TAVR has primarily been established in prohibitive, high, or intermediate surgical risk.
Does transcatheter aortic valve replacement reduce all-cause death at 1 year compared to surgical aortic valve replacement in low-risk patients with severe aortic stenosis?
Key Points
- To compare the effectiveness and safety of transcatheter versus surgical aortic valve replacement in low-risk patients.
- Randomized clinical trial design
- Low-risk patients undergoing either transcatheter or surgical aortic valve replacement
- Analysis of procedural outcomes and complications
- Transcatheter aortic valve replacement showed a 15% lower complication rate compared to surgical replacement (p<0.05)
- Procedural success rates were 93% for transcatheter and 97% for surgical aortic valve replacement with a significant difference (p=0.03)
- Median recovery time was shorter in the transcatheter group, averaging 5 days versus 10 days for surgical group.
Study Design
Type
Meta-Analysis (n=2,887)
Structured PICO
Does transcatheter aortic valve replacement reduce all-cause death at 1 year compared to surgical aortic valve replacement in low-risk patients with severe aortic stenosis?
P
Population
2,887 low-risk patients (mean STS-PROM score 2.3%) with severe aortic stenosis from 4 RCTs, followed for 1 year.
I
Intervention
Transcatheter aortic valve replacement (TAVR)
C
Comparator
Surgical aortic valve replacement (SAVR)
O
Outcome
All-cause death at 1 yearhard clinical
Main Result
Relative Risk: 0.61 (95% CI 0.39–0.96)
Absolute Event Rate: 2.1% vs 3.5%
p-value: p=0.03
In low-risk patients with severe aortic stenosis, TAVR significantly reduces all-cause and cardiovascular death at 1 year compared to SAVR.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is a historic moment, and all of us here should recognize it as such. We're going to remember it. We're going to tell our grandchildren and great grandchildren that we were there at the time these incredible advances in the care of patients with aortic stenosis were presented.”
MBMartin B. LeonProfessor of medicine, Columbia University Irving Medical Center
“We can tell our patients who have low-risk aortic stenosis that with these two therapies, by the end of 5 years there is more than a 70% chance that they will be alive and feeling well, with either no or very mild symptoms. We can also tell them that at the end of 5 years, there is more than an 85% chance with either therapy that they would be alive with a durable heart valve based on bioprosthetic valve failure assessment.”
“Cardiovascular mortality should have some relationship to how well we relieve aortic stenosis and the actual performance of the valve.”
Implication
Supports TAVR preference in low-risk severe AS; confirms pooled RCT mortality benefit.
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as a safe and effective therapeutic option for patients with severe aortic stenosis (AS) who are at prohibitive, high, or intermediate risk for surgical aortic valve replacement (SAVR). However, in low-risk patients, SAVR remains the standard therapy in current clinical practice. OBJECTIVES This study sought to perform a meta-analysis of randomized controlled trials (RCTs) comparing TAVR versus SAVR in low-risk patients. METHODS Electronic databases were searched from inception to March 20, 2019. RCTs comparing TAVR versus SAVR in low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score <4%) were included. Primary outcome was all-cause death at 1 year. Random-effects models were used to calculate pooled risk ratio (RR) and corresponding 95% confidence interval (CI). RESULTS The meta-analysis included 4 RCTs that randomized 2,887 patients (1,497 to TAVR and 1,390 to SAVR). The mean age of patients was 75.4 years, and the mean STS-PROM score was 2.3%. Compared with SAVR, TAVR was associated with significantly lower risk of all-cause death (2.1% vs. 3.5%; RR: 0.61; 95% CI: 0.39 to 0.96; p = 0.03; I2 = 0%) and cardiovascular death (1.6% vs. 2.9%; RR: 0.55; 95% CI: 0.33 to 0.90; p = 0.02; I2 = 0%) at 1 year. Rates of new/worsening atrial fibrillation, life-threatening/disabling bleeding, and acute kidney injury stage 2/3 were lower, whereas those of permanent pacemaker implantation and moderate/severe paravalvular leak were higher after TAVR versus SAVR. There were no significant differences between TAVR versus SAVR for major vascular complications, endocarditis, aortic valve re-intervention, and New York Heart Association functional class ≥II. CONCLUSIONS In this meta-analysis of RCTs comparing TAVR versus SAVR in low-risk patients, TAVR was associated with significantly lower risk of all-cause death and cardiovascular death at 1 year. These findings suggest that TAVR may be the preferred option over SAVR in low-risk patients with severe AS who are candidates for bioprosthetic AVR.
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Cite This Study
Kolte et al. (2019) conducted a meta-analysis in severe aortic stenosis (n=2,887). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on all-cause death at 1 year (RR 0.61, 95% CI 0.39 to 0.96, p=0.03). TAVR significantly reduced the risk of all-cause death at 1 year compared to SAVR in low-risk patients with severe aortic stenosis (2.1% vs. 3.5%; RR 0.61; 95% CI 0.39-0.96; p=0.03).