Midterm Survival of Low‐Risk Patients Treated with Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time to Event Data

In this meta‐analysis, the authors performed a pooled analysis of time‐to‐event data from Kaplan-Meier curves of randomized controlled trials (RCTs) and propensity‐score matched (PSM) studies comparing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in low-risk patients. The meta-analysis aimed to assess the midterm outcomes of both treatment strategies in low-risk patients. A total of eight studies (three RCTs, five PSM studies) published by December 31, 2022 met the eligibility criteria and included 5,444 patients. 2,639 patients underwent TAVR and 2,805 patients underwent SAVR. In low‐risk patients, TAVR showed a higher risk of all‐cause mortality at eight years of follow up. SAVR was associated with improved survival beyond two years. The survival benefit of SAVR was driven by PSM studies and could not be observed in RCTs. The addition of more extended follow up data from ongoing RCTs will help confirm the possible difference in mid and long term survival between TAVR and SAVR in the low‐risk population.