Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: Updated Meta-Analysis

Long-term data are essential for selection between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement in low-risk aortic stenosis (AS) patients. Given the recent randomized controlled trials (RCTs) and mid-term outcomes from existing trials, a reappraisal of the current literature is necessary. We systematically identified RCTs comparing TAVR and SAVR in low risk AS patients. A meta-analysis was performed using the reconstructed time-to-event data from published Kaplan-Meier curves. The outcome of interest was mid-term mortality. A stratified Cox model was used to calculate hazard ratios (HRs). Proportional hazard assumptions were tested, with landmark analysis and restricted mean survival time (RMST) analysis conducted accordingly. 7 RCTs including 5,740 patients (TAVR: 2,927; SAVR: 2,813) were included. At 5 years, TAVR was associated with reduced all-cause mortality (HR 0.83; 95% CI 0.70-1.00). Landmark analysis showed a significant survival benefit in the first year (HR 0.60; 95% CI 0.45-0.80), but not thereafter. The RMST analysis at 5 years favored TAVR by 1.01 months (p = 0.01). In low risk AS patients, TAVR demonstrated an early survival advantage. However, it remains uncertain whether this short-term benefit translates to long-term advantages. Long-term data are necessary to fully inform clinical practice.