Transcatheter better than surgical aortic valve replacement for patients with aortic stenosis

Transcatheter aortic valve replacement (TAVR) appears to be safer than surgical aortic valve replacement (SAVR) in low-risk aortic stenosis (AS) patients, with a significantly lower risk of all-cause and cardiovascular death at 1 year, a study has shown.

The investigators searched electronic databases from inception to 20 March 2019 for randomized controlled trials (RCTs) comparing TAVR and SAVR in low-risk patients (Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score <4 percent). All-cause death at 1 year was the primary outcome. Pooled risk ratio (RR) and 95 percent CI were calculated using random-effects models.

Four RCTs that randomized 2,887 patients (1,497 to TAVR and 1,390 to SAVR) met the eligibility criteria. Patients had a mean age of 75.4 years and mean STS-PROM score of 2.3 percent.

TAVR vs SAVR resulted in a significantly lower risk of all-cause (2.1 percent vs 3.5 percent; RR, 0.61, 95 percent CI, 0.39–0.96; p=0.03; I², 0 percent) and cardiovascular death (1.6 percent vs 2.9 percent; RR, 0.55, 0.33–0.90; p=0.02; I², 0 percent) at 1 year.

TAVR also led to lower rates of new/worsening atrial fibrillation, life-threatening/disabling bleeding and acute kidney injury stage 2/3, and higher rates of permanent pacemaker implantation and moderate/severe paravalvular leak compared with SAVR.

No significant between-group differences were observed for major vascular complications, endocarditis, aortic valve reintervention and New York Heart Association functional class ≥II.

“These findings suggest that TAVR may be the preferred option over SAVR in low-risk patients with severe AS who are candidates for bioprosthetic AVR,” the researchers said.