Transcatheter versus surgical aortic valve replacement: a meta-analysis of comparative outcomes in low- and intermediate-risk patients with severe aortic stenosis

Objective: Aortic stenosis is the most common valvular heart disease. This study aims to systematically analyze randomized clinical trials (RCTs) data comparing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in intermediate and low-risk patients with severe symptomatic aortic stenosis. Methods: We conducted a meta-analysis of RCTs, performing an exhaustive search of major databases to identify studies comparing TAVR and SAVR in low- to intermediate-risk patients. We assessed mortality, stroke, length of hospital stay, and other perioperative outcomes. Results: Nine RCTs with 8,884 patients (average age 77.76 years; 49.47% male) met the inclusion criteria. Baseline characteristics were comparable between TAVR and SAVR groups, with a low risk of bias. Pooled results showed a significant reduction in mortality for TAVR compared to SAVR (RR 0.75, 95% CI 0.61–0.92, p = 0.007, I² = 51%). TAVR significantly reduced stroke incidence (RR 0.66, 95% CI 0.49–0.89, p = 0.007, I² = 69%) and myocardial infarction (RR 0.60, 95% CI 0.37–0.96, p = 0.03, I² = 0%). No significant difference was found for prosthetic valve endocarditis (RR 1.06, 95% CI 0.55–2.06, p = 0.85, I² = 0%). Length of stay was significantly shorter for TAVR (MD -4.30 days, 95% CI -5.03 to -3.57, p = 0.00001, I² = 93%). Conclusion: TAVR is a viable option for intermediate and low-risk patients with severe symptomatic aortic stenosis. Future research should focus on long-term outcomes and TAVR device durability, especially in younger, lower-risk populations.