Key result
Pooled low-risk trials evaluate TAVI vs SAVR for late mortality over 7 years.
Why the study?
Extended follow-up from low-risk severe AS trials raised concerns that early TAVI advantages over SAVR attenuate over time with emerging signals for late mortality, valve durability, and reintervention. However, individual trials were underpowered for all-cause mortality, and conventional time-to-event analyses may obscure time-dependent differences.
Does transcatheter aortic valve implantation (TAVI) affect time-dependent late mortality compared with surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis over up to 7 years of follow-up?
Meta-Analysis
Does transcatheter aortic valve implantation (TAVI) affect time-dependent late mortality compared with surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis over up to 7 years of follow-up?
This pooled reconstructed time-to-event analysis of randomized low-risk trials evaluates time-dependent differences in late mortality up to 7 years between TAVI and SAVR in low-risk severe aortic stenosis.
Answers are grounded in this paper and cite their sources.
Extended TAVI-SAVR follow-up in low-risk aortic stenosis needs prospective validation; leaves open time-dependent late mortality differences up to 7 years.
The expansion of transcatheter aortic valve implantation (TAVI) to low-risk patients with severe aortic stenosis (AS) has been driven by randomized trials reporting favourable early outcomes and non-inferiority to surgical aortic valve replacement (SAVR), through early and intermediate follow-up.1 However, longer-term assessment is essential for patients with a longer life expectancy, in whom durability, reintervention risk, and survival are central to treatment selection.2 Recently released extended follow-up data from pivotal lower-risk trials have raised concerns that the early advantages of TAVI may attenuate over time, with emerging signals related to late mortality, valve durability, and reintervention.3–5 However, these trials were underpowered to evaluate all-cause mortality as an individual endpoint. Moreover, conventional time-to-event analyses may obscure clinically important time-dependent differences between two treatment strategies exhibiting non-parallel patterns of early and late risk. We therefore conducted a pooled reconstructed time-to-event analysis of randomized low-risk trials with extended follow-up of up to 7 years.
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Milojevic et al. (2026) conducted a meta-analysis in Low-risk severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on Time-dependent late all-cause mortality. Transcatheter aortic valve implantation vs surgical replacement was evaluated for time-dependent late mortality in a pooled analysis of low-risk trials over up to 7 years (no results in abstract).
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