TAVR vs. SAVR in Low-risk Aortic Stenosis: A Systematic Review and Meta-analysis of Safety and Efficacy
Destiny C. Chinuokwu *
Babcock University, Ilishan Remo, Nigeria.
Jingwa A. Klein
Kazan State Medical University, Kazan, Russia.
Daniel E. Otobrise
University of Medical Sciences, Ondo, Nigeria.
Peace Mordi
Gannan Medical University, Ganzhou, Jiangxi, Postal code: 341000, China.
Nwamaka C. Bob-Ume
All Saints University School of Medicine, St Vincent & The Grenadines.
Belinda A. Eze
St George’s Hospital, London, United Kingdom.
Ranjan Aishwarya
Kazan State Medical University, Kazan, Russia.
Abdelatty M.S. Abdelrahman
Kazan State Medical University, Kazan, Russia.
Vansh R. Roshni
Kazan State Medical University, Kazan, Russia.
Ezeamaku-Humphrey P. Chisom
First Moscow State Medical University ‘I.M. Sechenov’, Moscow, Russia.
Nasre S. Vaibhav
Kazan State Medical University, Kazan, Russia.
Yadav P. Cyrus
Kazan State Medical University, Kazan, Russia.
Msalm E.M. Manar
Kazan State Medical University, Kazan, Russia.
Cueva R.A. Nikol
Kazan State Medical University, Kazan, Russia.
Samuel F. Chidera
V.I. Vernadsky Crimean Federal University, Crimea, Ukraine.
*Author to whom correspondence should be addressed.
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.
Keywords: Aortic stenosis, low-risk patients, meta-analysis, Surgical Aortic Valve Replacement (SAVR), Transcatheter Aortic Valve Replacement (TAVR)