Key result
TAVR shows similar mid-term mortality and disabling stroke rates versus SAVR in low-to-moderate risk patients.
Why the study?
Mid-term results comparing transcatheter and surgical aortic valve replacement in low to moderate risk severe aortic stenosis patients remain contentious.
Does transcatheter aortic valve replacement reduce all-cause mortality and disabling stroke compared to surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low to moderate surgical risk?
Meta-Analysis (n=6,444)
Yes
Does transcatheter aortic valve replacement reduce all-cause mortality and disabling stroke compared to surgical aortic valve replacement in patients with symptomatic severe aortic stenosis at low to moderate surgical risk?
In low-to-moderate risk patients with severe aortic stenosis, transcatheter and surgical aortic valve replacement have similar mid-term rates of all-cause mortality and disabling stroke, though TAVR is associated with higher pacemaker rates and SAVR with higher atrial fibrillation rates.
Comparable mid-term mortality and stroke support either approach; extends short-term non-inferiority data while flagging 5-year mortality signals.
INTRODUCTION: Several clinical trials have demonstrated the non-inferiority of transcatheter aortic valve replacement compared with surgical aortic valve replacement in patients with severe aortic stenosis and low to intermediate surgical risk. However, mid-term results are still contentious. We performed this meta-analysis to compare the safety and efficacy of transcatheter vs. surgical aortic valve replacement in the mid-term in patients with aortic stenosis at low to moderate surgical risk. METHODS: We searched Embase, PubMed®, and Cochrane databases for randomized clinical trials that compared transcatheter with surgical aortic valve replacement in patients with symptomatic severe aortic stenosis with a follow-up of at least four years. Outcomes of interest were all-cause mortality and disabling stroke. RESULTS: We included six randomized clinical trials encompassing 6,444 patients with severe aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic valve replacement. There was no difference in all-cause mortality (risk ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25; P = 0.30) and disabling stroke (RR 0.95; 95% CI 0.75 - 1.21; P = 0.67) between groups. In the subgroup analysis, five-year mortality (RR 1.28; 95% CI 1.10 - 1.49) was higher in the transcatheter group. The new pacemaker implantation (RR 2.22; 95% CI 1.42 - 3.45) rate was higher in the transcatheter group. However, the new atrial fibrillation (RR 0.40; 95% CI 0.31 - 0.52) rate was higher in the surgical group. CONCLUSION: Mid-term mortality and disabling stroke rates in patients with severe aortic stenosis treated with either transcatheter or surgical aortic valve replacement were similar.
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Pascoal et al. (2026) conducted a meta-analysis in Severe aortic stenosis (n=6,444). Transcatheter aortic valve replacement (TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on All-cause mortality (RR 1.08, 95% CI 0.94 - 1.25, p=0.30). Transcatheter aortic valve replacement resulted in similar mid-term all-cause mortality (RR 1.08) and disabling stroke rates compared to surgical aortic valve replacement in patients with severe aortic stenosis at low to moderate surgical risk.
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