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July 27, 2026Journal of Thrombosis and Thrombolysis

TAVR matches SAVR for CV mortality and stroke in low-risk patients but increases pacemaker implants.

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Why the study?

Long-term comparative data against SAVR in low-surgical-risk populations were limited, particularly regarding valve durability and the need for reintervention.

Does transcatheter aortic valve replacement (TAVR) improve long-term clinical outcomes and valve durability compared to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis?

Comparison

TAVR vs SAVR

Design

Systematic review and meta-analysis of randomized trials

Follow-up

Ranging from 3 to 10 years

Key result

TAVR and SAVR resulted in similar cardiovascular mortality (HR 1.11; 95% CI 0.86-1.42; P=0.43) and stroke in low-risk patients, though TAVR was associated with more pacemaker implantations.

Authors

LRLakshiya RamamoorthyFOFaris OtmaniAGAarushi Gupta

Discussion

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Overview

TAVR viable for low-risk AS; extends RCT durability data but leaves open reintervention rates.

Key Points

  • This review aims to compare long-term outcomes, including durability and reintervention rates, between TAVR and SAVR in low-risk patients.
  • Conducted systematic review and meta-analysis of randomized trials through major databases.
  • Included trials with follow-up of at least three years and analyzed risk ratios and hazard ratios for outcomes.
  • Subgroup analyses by valve platform were performed.
  • Cardiovascular mortality (HR 1.11, 95% CI 0.86–1.42; P = 0.43) and stroke rates (HR 1.09, 95% CI 0.73–1.64; P = 0.67) showed no significant difference between groups.
  • Higher reintervention risk (RR 1.58, 95% CI 1.16–2.16) with TAVR but not significant per time-to-event analysis (HR 1.29, 95% CI 0.81–2.05).
  • Significant increase in pacemaker implantation after TAVR (RR 2.08, 95% CI 1.48–2.93; P < 0.0001), varying by valve platform.

Study Design

Type

Meta-Analysis (n=3,014)

Multicenter

Yes

Structured PICO

Does transcatheter aortic valve replacement (TAVR) improve long-term clinical outcomes and valve durability compared to surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis?

P
Population
3,014 patients with low surgical risk and severe aortic stenosis from 4 randomized trials followed for 3 to 10 years.
I
Intervention
Transcatheter aortic valve replacement (TAVR)
C
Comparator
Surgical aortic valve replacement (SAVR)
O
Outcome
Cardiovascular mortality and all-cause strokehard clinical

Main Result

Hazard Ratio: 1.11 (95% CI 0.86–1.42)

p-value: p=0.43

In low-risk patients with severe aortic stenosis, TAVR and SAVR demonstrate equivalent long-term cardiovascular mortality and stroke rates, though TAVR is associated with higher, platform-dependent rates of permanent pacemaker implantation.

Cite This Study

Ramamoorthy et al. (2026) conducted a meta-analysis in severe aortic stenosis (n=3,014). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Cardiovascular mortality (HR 1.11, 95% CI 0.86-1.42, p=0.43). TAVR and SAVR resulted in similar cardiovascular mortality (HR 1.11; 95% CI 0.86-1.42; P=0.43) and stroke in low-risk patients, though TAVR was associated with more pacemaker implantations.

synapsesocial.com/papers/6a670c7340bca442e0d4af75https://doi.org/10.1007/s11239-026-03368-3
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Long-Term Outcomes of Transcatheter vs Surgical Aortic Valve Replacement: Meta-analysis of Randomized Trials2024 · 18 citations
  2. 2Long‐Term Clinical and Angiographic Outcomes With Transcatheter Versus Surgical Aortic Valve Replacement in the Low‐ and Intermediate‐Risk Population: An Updated Meta‐Analysis of Randomized Controlled Trials2026
  3. 3Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients: An Update2026
  4. 4Long-Term Comparative Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR) in High-Risk Aortic Stenosis Patients: A Meta-Analysis2024
  5. 5Durability of Transcatheter and Surgical Bioprosthetic Aortic Valves in Patients at Lower Surgical Risk2019 · 323 citations