Transcatheter versus Surgical Aortic Valve Replacement for Intermediate-Risk Patients with Severe Aortic Stenosis: A Meta-Analysis

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR) has become the standard for inoperable or high-risk patients with aortic stenosis. Its role in intermediate-risk patients is the subject of ongoing evaluation. This review compares TAVR to surgical aortic valve replacement (SAVR) in this population.

Methods: A search of major databases was performed for RCTs that randomized intermediate-risk patients with severe aortic stenosis to either TAVR or SAVR. The primary outcome was a composite of all-cause mortality or disabling stroke.

Results: The meta-analysis of three large RCTs showed that at intermediate follow-up (1-2 years), TAVR was non-inferior to SAVR for the primary composite outcome. TAVR was associated with a lower risk of acute kidney injury and major bleeding, but a higher risk of vascular complications and need for a permanent pacemaker.

Discussion: In intermediate-risk patients, TAVR offers a less invasive alternative to SAVR with comparable short-to-intermediate term outcomes. The long-term durability of transcatheter valves remains a key question.

Conclusion: TAVR is a safe and effective alternative to surgery in intermediate-risk patients with severe aortic stenosis.