Comparing outcomes of TAVI and SAVR in low or intermediate risk symptomatic severe aortic stenosis: a systematic review and meta-analysis

Objectives To compare the mortality and clinical outcomes of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in patients with low- or intermediate-risk symptomatic severe aortic stenosis through an updated systematic review and meta-analysis of randomized controlled trials. Methods This systematic review was performed using PubMed, Medline, Embase, and Cochrane databases for RCTS between 2017 and 2024 which evaluated mortality outcomes in patients with low to intermediate risk AS who received TAVI vs. SAVR. Relative risks (RRs) with 95 % confidence intervals (CIs) were pooled using random effects models. Results TAVI showed a numerically lower but statistically insignificant mortality risk compared to SAVR (RR: 0.88, 95 % CI: 0.62–1.25, p=0.49). TAVI was associated with a higher risk of PPM insertion (RR: 2.19, 95 % CI: 1.55–3.16, p<0.001, i2: 80 %), aortic valve re-intervention (RR: 2.51, 95 % CI: 1.40–4.51, p<0.001; I 2 =0 %), new-onset bundle branch block (RR: 2.10, 95 % CI: 1.21–3.67, p<0.01; I 2 =84 %), and vascular site complications (RR: 4.77, 95 % CI: 2.11–10.81, p<0.001; I 2 =62 %). Atrial fibrillation incidence was lower with TAVI (RR: 0.29, 95 % CI: 0.23–0.38, p<0.001; I 2 =73). There was no significant difference in the rates of post-procedural myocardial infarction, stroke and endocarditis between TAVI and SAVR. Conclusions TAVI has mortality outcomes comparable to SAVR in low to intermediate risk patients. TAVI offers advantages in atrial fibrillation reduction, but is associated with increased risk of PPM insertion, vascular complications, new-onset bundle branch block, aortic valve re-intervention. Individualized treatment decisions remain important for optimizing outcomes in low to intermediate risk patients. Prospero registration number CRD42024547882.