Key result
TAVR shows similar stroke and mortality risk versus SAVR in low- and intermediate-risk severe AS.
Why the study?
Surgery is still preferred in younger and healthier patients with symptomatic severe aortic stenosis, although recent trials support comparable efficacy and safety of TAVR even in low-risk patients.
Does transcatheter aortic valve replacement reduce stroke compared to surgical aortic valve replacement in low- and intermediate-risk patients with symptomatic severe aortic stenosis?
Meta-Analysis
Does transcatheter aortic valve replacement reduce stroke compared to surgical aortic valve replacement in low- and intermediate-risk patients with symptomatic severe aortic stenosis?
Answers are grounded in this paper and cite their sources.
TAVR demonstrates comparable long-term clinical safety and efficacy to SAVR in low- and intermediate-risk patients with severe aortic stenosis, though it is associated with higher rates of pacemaker implantation and paravalvular leak.
Background Transcatheter aortic valve replacement (TAVR) is preferred over surgical aortic valve replacement (SAVR) in patients at high risk of morbidity or mortality from surgery. However, surgery is still preferred in younger and healthier patients with symptomatic severe aortic stenosis, although recent trials support comparable efficacy and safety of TAVR even in low‐risk patients. Methods An intention‐to‐treat analysis was conducted to construct a forest plot. The primary clinical outcome was the relative risk (RR) of stroke, and the secondary outcomes included the RR of all‐cause mortality, cardiovascular mortality, myocardial infarction, new‐onset atrial fibrillation, aortic reinterventions, and new permanent pacemaker implantation at the longest available follow‐up. Angiographic outcomes were measured in terms of the standardized mean difference (SMD) in effective orifice area (EOA) and the RR of paravalvular leakage (PVL). Subgroup analysis was performed for the clinical outcomes at a 5‐year follow‐up as well. Results No difference was seen between the two groups in terms of the RR of mortality (RR: 0.92, 95% CI: 0.75, 1.12) as well as stroke (RR: 1.05, 95% CI: 0.81, 1.35) in both the low‐ and intermediate‐risk patients and patients < 80 years old. The RR of cardiovascular mortality, disabling stroke, and myocardial infarction was also similar. Five‐year follow‐up did not show any significant difference in risk of mortality (RR: 0.97, 95% CI: 0.86, 1.11) or stroke (RR: 1.05, 95% CI: 0.89, 1.25). TAVR was associated with a lower risk of new‐onset atrial fibrillation (RR: 0.35, 95% CI: 0.25, 0.49, p < 0.00001). TAVR was associated with an increased risk of PVL (RR: 5.21; 95% CI: 2.70–10.07; p < 0.00001), aortic reintervention (RR: 1.95, 95% CI: 1.38, 2.77, p = 0002), and permanent pacemaker implantation (RR: 2.04, 95% CI: 1.55, 2.69, p < 0.00001). No statistically significant difference was found in the EOA; however, sensitivity analysis showed improved EOA with TAVR (SMD: 0.24, 95% CI: 0.12, 0.35). Conclusion TAVR is angiographically comparable and clinically as safe and effective as SAVR in low‐risk patients, even at longer follow‐up durations.
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Saleem et al. (2026) conducted a meta-analysis in Symptomatic severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Stroke (RR 1.05, 95% CI 0.81, 1.35). TAVR was associated with a similar risk of stroke (RR 1.05; 95% CI 0.81-1.35) and mortality compared to SAVR in low- and intermediate-risk patients with severe aortic stenosis.
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