Key result
Transcatheter aortic valve implantation showed no difference in long-term all-cause mortality compared to surgical replacement in RCTs (HR 0.97), but had higher mortality in real-world studies (HR 1.46).
Why the study?
The comparative safety and efficacy of transcatheter aortic valve replacement versus surgical aortic valve replacement in severe symptomatic aortic stenosis remain subjects of ongoing investigation.
Does transcatheter aortic valve replacement (TAVR) improve clinical outcomes and reduce procedural complications compared to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis?
Meta-Analysis (n=26,260)
Does transcatheter aortic valve replacement (TAVR) improve clinical outcomes and reduce procedural complications compared to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic stenosis?
Hazard Ratio: 0.97 (95% CI 0.88–1.07)
p-value: p=0.55
TAVR provides a less invasive alternative to SAVR with significant reductions in acute kidney injury, major bleeding, and new-onset atrial fibrillation, though it is associated with increased risks of permanent pacemaker implantation and vascular complications.
BACKGROUND: The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR), offering a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, the comparative safety and efficacy of these interventions remain subjects of ongoing investigation. AIM: SAVR in patients with severe symptomatic aortic stenosis. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) comparing TAVR and SAVR were identified from databases including PubMed, Scopus, and Web of Science up to May 31, 2024. Data were extracted on clinical outcomes, including mortality, procedural complications, and post-procedure adverse events. Risk ratios (RRs) with 95%CIs were calculated using a random-effects model. RESULTS: A total of 10 RCTs were included. TAVR demonstrated a significantly lower risk of acute kidney injury (RR: 0.33; 95%CI: 0.25-0.44), major bleeding (RR: 0.37; 95%CI: 0.30-0.46), and new-onset atrial fibrillation (RR: 0.44; 95%CI: 0.34-0.57) compared to SAVR. However, TAVR was associated with higher risks of new permanent pacemaker implantation (RR: 3.49; 95%CI: 2.77-4.39), major vascular complications (RR: 2.47; 95%CI: 1.91-3.21), and paravalvular leaks (RR: 4.15; 95%CI: 3.14-5.48). Mortality at 30 days was comparable (RR: 0.95; 95%CI: 0.78-1.15), but long-term mortality was slightly higher with TAVR in some analyses (RR: 1.23; 95%CI: 1.01-1.49). Rates of stroke (RR: 0.97; 95%CI: 0.81-1.17) and myocardial infarction (RR: 0.91; 95%CI: 0.67-1.24) were similar between the groups. CONCLUSION: TAVR offers a less invasive option with significant benefits in reducing acute kidney injury, major bleeding, and new-onset atrial fibrillation, making it particularly advantageous for high-risk surgical candidates. However, higher risks of permanent pacemaker implantation, vascular complications, and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
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Moradi et al. (2025) conducted a meta-analysis in Severe aortic stenosis (n=26,260). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on Long-term (≥2-year) all-cause mortality (RCT pooled analysis) (HR 0.97, 95% CI 0.88-1.07, p=0.55). Transcatheter aortic valve implantation showed no difference in long-term all-cause mortality compared to surgical replacement in RCTs (HR 0.97), but had higher mortality in real-world studies (HR 1.46).
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