Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients with Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials

Abstract

Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at mid-term follow-up while limited long-term (≥ 3-year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients.We searched databases up to July 7th 2024, for randomized clinical trials (RCTs) comparing TAVR versus SAVR in low-risk patients (defined as STS-PROM Score less than 4%). (PROSPERO ID: CRD42023480495).Primary outcome analysed was all-cause death at minimum 3-year follow-up. Secondary outcomes were: cardiovascular death, disabling stroke, myocardial infarction (MI), aortic valve reintervention, endocarditis, new-onset atrial fibrillation, permanent pacemaker implantation (PPI) and bioprosthetic valve failure (BVF).A total of 3 RCTs with 2,644 patients (TAVR, n=1,371 patients; SAVR, n=1,273 patients) were included. Follow-up time was 6 ± 2.9 years. TAVR resulted non-inferior to SAVR for all-cause death [RR: 0.99 (95% CI: 0.84-1.17; p=0.89; I2=28%)], cardiovascular death [RR: 0.94 (95% CI: 0.76-1.15; p=0.54; I2=0%)], MI [RR: 1.06 (95% CI: 0.71-1.57; p=0.79; I2=61%)], aortic valve reintervention, endocarditis and BVF. New-onset atrial fibrillation was higher in the SAVR group, while PPI in the TAVR group.In conclusion our meta-analysis showed that TAVR is associated with similar long-term outcomes compared to SAVR in selected, low-risk patients.