Transcatheter Versus Surgical Aortic Valve Replacement in Low-Surgical-Risk Patients: A Meta-Analysis of Randomized-Controlled Trials and Propensity-Matched Studies.

Background: We performed a meta-analysis of randomized trials (RCT) and propensity-matched (PSM) studies comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low surgical risk patients.

Methods: Published studies including low-risk patients who underwent TAVI (n = 9068) or SAVR (n = 17,388) were included. Outcomes of interest were short-term (30-day) and mid-term (1-year) mortality and major complications.

Results: Short-term mortality was lower with TAVI vs. SAVR (1.8% vs. 2.8%, RR = 0.67, [0.56-0.80]). TAVI was associated with lower risk of atrial fibrillation (7.4% vs. 36.5%, RR = 0.21, [0.14-0.31]), and kidney injury (5.3% vs. 9%, RR = 0.45, [0.26-0.80]), but had higher incidence of vascular complications (5.5% vs. 1.4%, RR = 4.88 [1.47-16.18]), and permanent pacemaker implantation (14.9% vs. 3.4%, RR = 4.94 [3.03-8.08]). Stroke rates were similar between both interventions (1.7% vs. 2.2%, RR = 0.80 [0.54-1.18]). Mid-term all-cause mortality was similar in the pooled analysis for TAVI vs. SAVR (8.6% vs. 8.4%, RR = 0.90 [0.66-1.24]), but was lower with TAVI in RCTs (2.1% vs. 3.5%, RR = 0.61 [0.39-0.95]). Cardiovascular mortality was lower with TAVI (1.6% vs. 2.9%, RR = 0.55 [0.33-0.90]), but stroke (3% vs. 4.2%, RR = 0.69, [0.45-1.06]) and valve re-interventions rates (0.8% vs. 0.6%, RR = 1.28 [0.52-3.17]) were similar between both strategies.

Conclusion: TAVI in low surgical risk patients is associated with lower short-term morbidity and mortality compared with SAVR.