Abstract 4147770: TAVR versus SAVR for Severe Aortic Stenosis in the Low and Intermediate Surgical Risk Population: A Meta-Analysis of Randomized Controlled Trials

Background: Randomized control trials (RCTs) have compared transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS) at low-intermediate surgical risk. Objective: To compare TAVR vs. SAVR for AS in low-intermediate surgical risk patients. Methods: We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing TAVR with SAVR for AS in low-intermediate surgical risk. Outcomes included composite death or stroke, death, stroke, myocardial infarction (MI), cardiac death, new atrial fibrillation (AF), new pacemaker implantation, acute kidney injury (AKI), bleeding, major vascular complications, endocarditis, aortic valve reintervention, and rehospitalization at 1 year. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I 2 statistics. Results: The systematic review identified 8 RCTs including 9,239 patients (TAVR n=4,695, 50.8%). Death or stroke (RR 0.78; 95%CI 0.62-0.98; p=0.033; I 2 =52%), cardiac death (RR 0.79; 95%CI 0.63-0.98; p=0.029; I 2 =1%), bleeding (RR 0.39; 95%CI 0.25-0.60; p<0.001; I 2 =94%), new AF (RR 0.28; 95%CI 0.20-0.40; p<0.001; I 2 =83%), and AKI (RR 0.50; 95%CI 0.35-0.70; p<0.001; I 2 =0%) were lower with TAVR. New pacemaker implantation (RR 2.25; 95%CI 1.50-3.39; p<0.001; I 2 =86%) and aortic valve reintervention (RR 1.95; 95%CI 1.19-3.20; p=0.008; I 2 =0%) were higher with TAVR. Death, stroke, MI, major vascular complications, endocarditis, and rehospitalization were comparable. Conclusion: In low-intermediate surgical risk patients, TAVR carries a lower risk of major adverse outcomes than SAVR.