Comparative outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in severe aortic stenosis: a systematic review and meta-analysis

Abstract Introduction Aortic stenosis (AS) is a progressive and potentially fatal condition characterized by narrowing of the aortic valve, which leads to increased strain on the heart. Severe AS is commonly treated with either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). While TAVR has become a less invasive alternative to SAVR, its long-term effectiveness compared to SAVR, especially in terms of survival, complications, and recovery, remains unclear. Multiple studies have investigated the outcomes of these two approaches, but a comprehensive comparison is still needed. Purpose This meta-analysis aims to systematically evaluate and compare the outcomes of TAVR and SAVR in patients with severe aortic stenosis. By synthesizing data from multiple studies, this analysis seeks to provide a robust assessment of the relative effectiveness and safety of these two treatment strategies, focusing on key clinical outcomes such as all-cause mortality,cardiovascular mortality, stroke, pacemaker implantation, major bleeding, acute kidney injury, atrial fibrillation, respiratory complications and length of hospital stay. Methods A systematic literature search was conducted across major databases (PubMed, Cochrane Library, and Scopus) for studies comparing TAVR and SAVR in patients with severe aortic stenosis. Studies included randomized controlled trials (RCTs), cohort studies, and observational studies. A total of 8 studies are included in this meta-analysis. Results TAVR demonstrated significant reductions in several key outcomes compared to SAVR. All-cause mortality was reduced by 28% (OR = 0.72, 95% CI 0.53, 0.98, p = 0.04)(figure A), cardiovascular mortality by 37% (OR = 0.63, 95% CI 0.42, 0.93(figure B), p = 0.02), and major bleeding by 56% (OR = 0.44, 95% CI 0.27, 0.71, p = 0.0007)(figure E). Additionally, TAVR led to a 49% reduction in acute kidney injury (OR = 0.51, 95% CI 0.26, 0.99, p = 0.05)(figure F), a 66% reduction in atrial fibrillation (OR = 0.34, 95% CI 0.17, 0.67, p = 0.002)(figure G), and a 57% reduction in respiratory complications (OR = 0.43, 95% CI 0.26, 0.71, p = 0.001)(figure H). TAVR also shortened hospital stays by a mean difference of -3.39 days (SD -3.56, -3.21, p 0.00001)(figure I). However, no significant difference was observed in stroke rates between the two procedures (OR = 1.04, 95% CI 0.71, 1.51, p = 0.85)(figure C). TAVR was associated with a higher rate of pacemaker implantation, favoring SAVR (OR = 2.28, 95% CI 1.62, 3.20, p 0.00001)(figure D). Conclusion In conclusion, TAVR offers significant advantages over SAVR in reducing mortality, bleeding, kidney injury, atrial fibrillation, and hospital stay. However, it is associated with a higher pacemaker implantation rate, and no difference in stroke rates was found.