Transcatheter versus Surgical Aortic Valve Replacement in Low-Risk Patients: Updated Meta-Analysis.

Background Long-term data are essential for selection between transcatheter (TAVR) and surgical (SAVR) aortic valve replacement in low-risk aortic stenosis (AS) patients. Given the recent randomized controlled trials (RCTs) and mid-term outcomes from existing trials, a reappraisal of the current literature is necessary. Methods We systematically identified RCTs comparing TAVR and SAVR in low risk AS patients. A meta-analysis was performed using the reconstructed time-to-event data from published Kaplan-Meier curves. The outcome of interest was mid-term mortality. A stratified Cox model was used to calculate hazard ratios (HRs). Proportional hazard assumptions were tested, with landmark analysis and restricted mean survival time (RMST) analysis conducted accordingly. Results Seven RCTs including 5,740 patients (TAVR: 2,927; SAVR: 2,813) were included. At 5 years, TAVR was associated with reduced all-cause mortality (HR 0.83; 95% CI 0.70-1.00). Landmark analysis showed a significant survival benefit in the first year (HR 0.75; 95% CI 0.61-0.93), but not thereafter. The RMST analysis at 5 years favored TAVR by 1.01 months (p=0.011). Conclusions In low risk AS patients, TAVR demonstrated an early survival advantage. However, it remains uncertain whether this short-term benefit translates to long-term advantages. Long-term data are necessary to fully inform clinical practice.