TAVR vs. SAVR in Low-risk Aortic Stenosis: A Systematic Review and Meta-analysis of Safety and Efficacy

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is a transformative intervention for severe aortic stenosis (AS), particularly in high- and intermediate-risk patients. However, its role in low-risk individuals remains under investigation. Aim: This systematic review and meta-analysis aimed to compare the safety and efficacy of TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients, focusing on mortality and procedural outcomes. Methods: We included randomized controlled trials (RCTs) comparing TAVR and SAVR in patients with severe AS and a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score <4%. A thorough search of PubMed, EMBASE, and the Cochrane Library was conducted during 2019. The Cochrane Risk of Bias tool was used to assess methodological quality. Random-effects meta-analysis was performed to estimate pooled risk ratios (RRs) and 95% confidence intervals (CIs) for key outcomes. Results: Four RCTs involving 2,887 patients (1,497 TAVR; 1,390 SAVR) were included. The mean age was 75.4 years, and the average STS-PROM score was 2.3%. At 1-year follow-up, TAVR reduced all-cause mortality (RR: 0.61; 95% CI: 0.39–0.96) and cardiovascular mortality (RR: 0.55; 95% CI: 0.33–0.90). TAVR was also associated with lower risks of atrial fibrillation, bleeding, and acute kidney injury but higher rates of pacemaker implantation and paravalvular leak. Conclusion: The growing evidence supports TAVR as a favorable alternative to SAVR in appropriately selected low-risk patients undergoing bioprosthetic aortic valve replacement. However, ongoing surveillance of long-term clinical outcomes and prosthetic valve durability remains essential to fully establish the role of TAVR in this population.