# Mid-term Outcomes of Transcatheter Aortic Valve Replacement vs. Surgical Aortic Valve Replacement in Low-to-Moderate Risk Patients with Severe Aortic Stenosis: A Systematic Review and Meta-analysis

## TL;DR

This study compares mid-term outcomes of two heart valve replacement methods in patients with severe aortic stenosis and finds similar mortality and stroke rates.

## Contribution

A meta-analysis comparing mid-term safety and efficacy of transcatheter and surgical aortic valve replacement in low-to-moderate risk patients.

## Key findings

- Mid-term all-cause mortality and disabling stroke rates were similar between transcatheter and surgical aortic valve replacement.
- Transcatheter valve replacement was associated with higher five-year mortality and higher pacemaker implantation rates.
- Surgical valve replacement was linked to higher rates of new atrial fibrillation.

## Abstract

Several clinical trials have demonstrated the non-inferiority of
transcatheter aortic valve replacement compared with surgical aortic valve
replacement in patients with severe aortic stenosis and low to intermediate
surgical risk. However, mid-term results are still contentious. We performed
this meta-analysis to compare the safety and efficacy of transcatheter
vs. surgical aortic valve replacement in the mid-term
in patients with aortic stenosis at low to moderate surgical risk.

We searched Embase, PubMed®, and Cochrane databases for randomized
clinical trials that compared transcatheter with surgical aortic valve
replacement in patients with symptomatic severe aortic stenosis with a
follow-up of at least four years. Outcomes of interest were all-cause
mortality and disabling stroke.

We included six randomized clinical trials encompassing 6,444 patients with
severe aortic stenosis, of whom 3,282 (50.9%) underwent transcatheter aortic
valve replacement. There was no difference in all-cause mortality (risk
ratio [RR] 1.08; 95% confidence interval [CI] 0.94 - 1.25;
P = 0.30) and disabling stroke (RR 0.95; 95% CI 0.75 -
1.21; P = 0.67) between groups. In the subgroup analysis,
five-year mortality (RR 1.28; 95% CI 1.10 - 1.49) was higher in the
transcatheter group. The new pacemaker implantation (RR 2.22; 95% CI 1.42 -
3.45) rate was higher in the transcatheter group. However, the new atrial
fibrillation (RR 0.40; 95% CI 0.31 - 0.52) rate was higher in the surgical
group.

Mid-term mortality and disabling stroke rates in patients with severe aortic
stenosis treated with either transcatheter or surgical aortic valve
replacement were similar.