Key result
Early TAVR yields no 2-year mortality benefit over surveillance in moderate AS despite fewer HF hospitalizations.
Why the study?
Moderate AS is associated with excess mortality, prompting this study to estimate the effects of early TAVR versus clinical surveillance across 2 recent randomized trials and to compare randomized with observational estimates.
Does early transcatheter aortic valve replacement reduce mortality and heart failure hospitalization compared to clinical surveillance in patients with moderate aortic stenosis?
Meta-Analysis (n=922)
Does early transcatheter aortic valve replacement reduce mortality and heart failure hospitalization compared to clinical surveillance in patients with moderate aortic stenosis?
In older, predominantly symptomatic patients with moderate aortic stenosis, early TAVR does not appear to reduce 2-year mortality compared to surveillance, though it reduces heart failure hospitalizations at the expense of higher pacemaker rates.
Answers are grounded in this paper and cite their sources.
Supports early TAVR in moderate AS with at-risk features; extends RCT evidence beyond observational associations.
BACKGROUND: Moderate aortic stenosis (AS) is associated with excess mortality, and 2 randomized trials have tested early transcatheter aortic valve replacement (TAVR). OBJECTIVES: The authors sought to estimate the effects of early TAVR vs clinical surveillance and to compare randomized with observational estimates. METHODS: Six databases and registries were searched through November 3, 2026. Adjusted observational studies were synthesized separately from trials. Certainty was rated with GRADE. RESULTS: Two trials (922 patients; TAVR UNLOAD, n = 178, HF with reduced ejection fraction; PROGRESS, n = 744, 96.4% symptomatic) and 7 cohorts were included. Early TAVR did not detectably change death over approximately 2 years (HR: 1.05; 95% CI: 0.74-1.49; low certainty), with one-fifth of the deaths needed to detect a 20% reduction. Heart failure (HF) hospitalization was lower (RR: 0.53; 95% CI: 0.36-0.77; low certainty), or 70 fewer patients per 1,000 at 2 years. New pacemakers were more frequent (PROGRESS: 17.3% vs 9.3%; moderate certainty). About half of surveillance patients underwent valve replacement within 2 years. Observational cohorts estimated a 48% mortality reduction (HR: 0.52; 95% CI: 0.43-0.64; very low certainty), which differed from the randomized estimate (ratio of HRs: 2.01; 95% CI: 1.37-2.95). CONCLUSIONS: In older, predominantly symptomatic patients with moderate AS, early TAVR may make little or no difference to 2-year mortality and may reduce HF hospitalization, at the cost of more pacemakers. Because about half of patients under surveillance receive a valve within 2 years, the decision largely concerns timing. Observational survival estimates should not guide practice.
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Majed et al. (2026) conducted a meta-analysis in Moderate aortic stenosis (n=922). Early transcatheter aortic valve replacement (TAVR) vs. Clinical surveillance was evaluated on All-cause mortality (death) (HR 1.05, 95% CI 0.74-1.49). Early TAVR vs surveillance in moderate AS did not change 2-year mortality in trials (HR 1.05; 95% CI 0.74-1.49) but reduced HF hospitalization (RR 0.53; 95% CI 0.36-0.77).
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