Abstract 4124369: Mid-term Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Low to Moderate Risk Patients with Severe Aortic Stenosis: A Meta-analysis of Randomised Clinical Trials

Background: Several clinical trials have demonstrated non-inferiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low to intermediate surgical risk. However, mid-term results are still contentious. Question: Is TAVR superior to SAVR in the mid-term in terms of mortality outcomes or adverse cardiovascular events? Methods: We searched Embase, Pubmed and Cochrane databases for RCTs that compared TAVR with SAVR in patients with symptomatic severe AS with a follow-up of at least 4 years. Outcomes of interest were all-cause mortality and disabling stroke. Results: We included six RCTs involving 6,444 patients with severe AS, of whom 3,282 (50.9%) underwent TAVR. There was no difference in mortality from all causes (RR 1.08; 95%CI 0.94-1.25; p=0.30; I 2 =45%) and disabling stroke (RR 0.95; 95%CI 0.75-1.21; p=0.67; I 2 =9%) between groups. In the subgroup analysis, 5-year mortality (RR 1.28; 95%CI 1.10-1.49; I 2 =0%) was higher in the TAVI group. The new pacemaker implantation rate was higher in the TAVI group (RR 2.22; 95%CI 1.42-3.45; p=0.0004 ; I 2 =91%). However, new atrial fibrillation rate was higher in the SAVR group (RR 0.42; 95%CI 0.37-0.49; p=0.00001; I 2 =62%). Conclusion: Mid-term mortality and disabling stroke of patients with severe AS treated with TAVR or SAVR were similar.