SAVR or TAVI, which gives better outcomes in patients with severe aortic stenosis? Meta-analysis provides insights

A random-effects meta-analysis was conducted. It included eight RCTs with 8698 patients. The primary endpoints included strokes, death, and the composite of disabling stroke or death, occurring at one year (early) or after one year (later).

The study revealed the following findings:

• In lower-risk patients, at one year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67], as was death or disabling stroke (RR 0.68).
• There were no differences in strokes. After one year, in lower-risk patients, there were no significant differences in all primary outcomes.
• In higher-risk patients, there were no significant differences in primary outcomes.
• New-onset atrial fibrillation, acute kidney injury, and major bleeding occurred less after TAVI; new pacemakers, vascular complications, and the paravalvular leak occurred more after TAVI.

The researchers found an early mortality reduction with TAVI but no differences following later follow-up in lower-risk patients. Also, there was an early reduction in the composite of disabling stroke or death, with no difference at later follow-up.

"For higher-risk patients, there were no significant differences," the researchers wrote. "Informed therapy decisions may depend more on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes."

Reference:

Yousif Ahmad, James P Howard, Ahran D Arnold, Mahesh V Madhavan, Christopher M Cook, Maria Alu, Michael J Mack, Michael J Reardon, Vinod H Thourani, Samir Kapadia, Hans Gustav Hørsted Thyregod, Lars Sondergaard, Troels Højsgaard Jørgensen, William D Toff, Nicolas M Van Mieghem, Raj R Makkar, John K Forrest, Martin B Leon, Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials, European Heart Journal, 2023;, ehac642, https://doi.org/10.1093/eurheartj/ehac642