TAVI vs SAVR in severe aortic stenosis: A systematic review

Severe aortic stenosis (AS) represents a major burden among elderly patients, with high mortality once symptoms develop. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement (SAVR), expanding from inoperable to low-risk populations. This systematic review compares short- and long-term outcomes between TAVI and SAVR in patients with severe AS. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched (2010–2025). Eligible randomized controlled trials (RCTs) and comparative cohorts reporting mortality, stroke, pacemaker, or valve durability were included. Twenty-one studies (16 RCTs, 5 registries; n≈23,000) were analyzed. Thirty-day mortality was similar (RR 0.94, 95% CI 0.82–1.07). TAVI reduced bleeding (RR 0.63) and acute kidney injury (RR 0.71) but increased pacemaker implantation (RR 2.46) and paravalvular leak (RR 3.32). Five-year results (PARTNER 3, NOTION) showed comparable survival and valve durability. TAVI provides equivalent survival and superior early recovery compared to SAVR, although conduction disturbances and leak remain limitations. SAVR remains preferred for younger or bicuspid patients pending longer durability data.