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. 2025 Mar 6:12:1479200.
doi: 10.3389/fcvm.2025.1479200. eCollection 2025.

Longer-term and landmark analysis of transcatheter vs. surgical aortic-valve implantation in severe aortic stenosis: a meta-analysis

Yu Wang #  1 , Xiaowen Zhang #  2 , Xinlin Zhang  1 , Wei Xu  1
Affiliations

Longer-term and landmark analysis of transcatheter vs. surgical aortic-valve implantation in severe aortic stenosis: a meta-analysis

Yu Wang et al. Front Cardiovasc Med. .

Abstract

Background: Previous reports of longer-term outcomes of transcatheter aortic valve implantation (TAVI) focus on higher risk patients and suggest potential temporal changes.

Aims: To evaluate the longer-term and temporal performances of TAVI compared to surgical aortic valve replacement (SAVR).

Methods: Randomized controlled trials reporting outcomes with at least 1-year follow-up. The primary outcome was the composite of all-cause death or disabling stroke.

Results: We included 8 trials with 8,749 patients. TAVI was associated with a higher risk of longer-term (5-year) primary outcome compared to SAVR among higher-risk [odds ratio (OR), 1.25; 95% CI, 1.07-1.47] but not lower-risk participants [1.0 (0.77-1.29)]. However, a significant temporal interaction was detected in both risk profiles. TAVI with balloon-expandable valves was associated with a higher risk of longer-term primary outcome compared to SAVR [1.38 (1.2-1.6)], whereas no statistical difference was found with self-expanding valves [1.03 (0.89-1.19)]. There was a significant interaction between the two valve systems, and a temporal interaction was detected in both systems. Overall landmark analysis revealed a lower risk in TAVI within the initial 30 days [0.76 (0.6, 0.96)], comparable between 30 days to 2 years [1.04 (0.85, 1.28)], and higher beyond 2 years [1.36 (1.15-1.61)]. Analysis for all-cause death generated largely similar results.

Conclusions: TAVI was associated with a higher longer-term risk of primary outcome compared to SAVR in higher-risk patients and with balloon-expandable valves. However, a characteristic temporal interaction was documented in all subgroups. Future studies are warranted to test these findings.

Keywords: SAVR; TAVI; aortic stenosis; longer-term; randomized controlled trials (RCT).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Risk estimates of all-cause death or disabling stroke for TAVI vs SAVR stratified by surgical risks at different lengths of follow-up.
Figure 2
Figure 2
Landmark risk estimates of all-cause death or disabling stroke for TAVI vs SAVR stratified by surgical risks.
Figure 3
Figure 3
Risk estimates of all-cause death or disabling stroke for TAVI vs SAVR stratified by TAVI valve systems at different lengths of follow-up.
Figure 4
Figure 4
Landmark risk estimates of all-cause death or disabling stroke for TAVI vs SAVR stratified by TAVI valve systems.
Central Illustration
Central Illustration
Risk estimates of all-cause death or disabling stroke for TAVI vs SAVR.
See this image and copyright information in PMC

References

    1. Mori M, Gupta A, Wang Y, Vahl T, Nazif T, Kirtane AJ, et al. Trends in transcatheter and surgical aortic valve replacement among older adults in the United States. J Am Coll Cardiol. (2021) 78(22):2161–72. 10.1016/j.jacc.2021.09.855 - DOI - PubMed
    1. Zhang XL, Zhang XW, Lan RF, Chen Z, Wang L, Xu W, et al. Long-term and temporal outcomes of transcatheter versus surgical aortic-valve replacement in severe aortic stenosis: a meta-analysis. Ann Surg. (2021) 273(3):459–66. 10.1097/SLA.0000000000003906 - DOI - PubMed
    1. Gleason TG, Reardon MJ, Popma JJ, Deeb GM, Yakubov SJ, Lee JS, et al. 5-year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol. (2018) 72(22):2687–96. 10.1016/j.jacc.2018.08.2146 - DOI - PubMed
    1. Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. (2015) 385(9986):2477–84. 10.1016/S0140-6736(15)60308-7 - DOI - PubMed
    1. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. (2020) 382(9):799–809. 10.1056/NEJMoa1910555 - DOI - PubMed

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