387 Temporal trends in outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in low-risk patients with aortic stenosis: a meta-analysis of randomized controlled trials
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Authors
Paray, Nitish Behary
Issue Date
2026
Type
Article
Language
en
Keywords
Wessex Classification Subject Headings::Cardiology
Alternative Title
Abstract
Introduction Surgical aortic valve replacement (SAVR) has long been the standard treatment for patients with severe aortic stenosis (AS) at low surgical risk. However, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative. This meta-analysis compares the efficacy and safety of TAVR versus SAVR in low-risk AS patients across different follow-up intervals.
Methods A systematic search of PubMed, Embase, and the Cochrane Library was performed through September 2024. Six randomized controlled trials (RCTs) and eight follow-up reports were included (n = 11,953). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model via Revman (Version 5.4.1).
Results At 30 days, there was no significant difference in all-cause or cardiovascular mortality between TAVR and SAVR. At 1 year, TAVR significantly reduced all-cause mortality (RR: 0.61; P = 0.0009) (figure 1) and cardiovascular mortality (RR: 0.62; P = 0.006) (figure 2), with no differences at 2 years or beyond 5 years. Stroke and myocardial infarction rates were comparable at all follow-up points. TAVR markedly reduced new-onset or worsening atrial fibrillation (AF) at 30 days (RR: 0.19; P < 0.00001), 1 year (RR: 0.24; P < 0.00001), 2 years (RR: 0.27; P < 0.00001), and ≥5 years (RR: 0.45; P = 0.001) (figure 3). Major bleeding was significantly lower with TAVR at 30 days (RR: 0.29; P < 0.00001) and 1 year (RR: 0.31; P < 0.00001) (figure 4). In contrast, TAVR increased major vascular complications at 30 days (RR: 2.19; P = 0.05) (figure 5) and permanent pacemaker implantation at 30 days (RR: 2.73; P = 0.002), 1 year (RR: 2.29; P < 0.0001), 2 years (RR: 3.38; P = 0.009), and ≥5 years (RR: 2.19; P = 0.001) (figure 6). Hospitalizations were reduced with TAVR at 30 days (RR: 0.52; P = 0.007) and 1 year (RR: 0.72; P = 0.04), with no long-term difference (figure 7).
Conclusion In low-risk AS patients, TAVR offers early benefits, including lower 1-year mortality, bleeding, AF endocarditis and hospitalization, but these advantages wane over time. Higher rates of pacemaker implantation and vascular complications highlight the need to weigh short-term gains against long-term risks when selecting treatment.
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Citation
Nawaz M, Sirajuddin K, Alowami M, et al387 Temporal trends in outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in low-risk patients with aortic stenosis: a meta-analysis of randomized controlled trialsHeart 2026;112:A8-A9.