Transcatheter vs Surgical Aortic Valve Replacement in Lower-Risk Patients: An Updated Meta-Analysis of Randomized Controlled Trials.

Summary

Across six RCTs (n=5,341) with reconstructed IPD survival analyses, TAVR reduced the 5-year hazard of all-cause death (HR 0.80) and death or disabling stroke (HR 0.81) versus SAVR, with similar stroke rates. Weighted mean follow-up was 35.7 months; authors caution that not all cohorts have reached 5 years.

Key Findings

• Six RCTs (n=5,341) in lower-risk severe AS were pooled using reconstructed time-to-event IPD.
• At 5 years, TAVR reduced all-cause mortality (HR 0.80) and death or disabling stroke (HR 0.81) vs SAVR.
• Stroke rates were similar between TAVR and SAVR (HR 0.97).
• Weighted mean follow-up was 35.7 months; many patients have not completed full 5-year follow-up.

Clinical Implications

For suitable lower-risk AS patients, TAVR can be favored given reduced death or disabling stroke at 5 years, while ongoing surveillance for valve durability and very long-term outcomes remains essential, especially in younger cohorts.

Limitations

• Not all trials have complete 5-year follow-up; device generations and surgical techniques vary.
• Reconstructed IPD may introduce approximations; durability beyond 5 years remains uncertain.

Future Directions

Extended follow-up beyond 5–10 years with device-specific analyses; randomized comparisons in younger populations; integration of valve durability, reintervention, and quality-of-life endpoints.