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. 2025 Jun 26:12:1555853.
doi: 10.3389/fcvm.2025.1555853. eCollection 2025.

Evaluating long-term outcomes and the impact of small aortic annulus on valve replacement-a novel systematic review and meta-analysis comparing surgery vs. transcatheter interventions

Aamir Amin  1 , Cara Mohammed  2 , Sten Kajitani  3 , Khalid AlMashari  4 , Rajanikant Kumar  5 , Alifa Sabir  6 , Paulina Briz-Echeverria  7 , Shiva Mokhtassi  1 , Shashi Kumar Kallikere Lakshmana  8 , Ahmed Bokhari  9 , Muhammad Ehsan  10 , Hasan Ahmad  11 , Raheel Ahmed  11 , Toufan Bahrami  12
Affiliations

Evaluating long-term outcomes and the impact of small aortic annulus on valve replacement-a novel systematic review and meta-analysis comparing surgery vs. transcatheter interventions

Aamir Amin et al. Front Cardiovasc Med. .

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is often compared to surgical aortic valve replacement (SAVR) for aortic stenosis treatment. This meta-analysis evaluates the long-term efficacy and safety of TAVI vs. SAVR in aortic stenosis patients, as well as their respective impact on patients with small aortic annulus (SAA).

Methods: MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) and comparative observational studies on TAVI vs. SAVR with long-term follow-up (3-5 years) or SAA. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and the Newcastle Ottawa Scale. Meta-analyses were conducted with RevMan 5.4 using a random-effects model, with risk ratio (RR) and mean difference (MD) as effect measures.

Results: A total of 17 studies were included in our review. In the long-term analysis, all-cause mortality was significantly higher in the TAVI group [RR 1.10; 95% CI: 1.01-1.19], but the incidence of major bleeding [RR 0.79; 95% CI: 0.68-0.90] and atrial fibrillation was significantly lower [RR 0.37; 95% CI: 0.29-0.48] in the TAVI group. No significant difference was found between the two groups regarding other long-term outcomes. For SAA outcomes, there was no significant difference in terms of all-cause mortality [RR 0.92; 95% CI: 0.63-1.35], although cardiovascular mortality was significantly increased in the TAVI group [RR 2.08; 95% CI: 1.09-3.98]. TAVI significantly increased the rate of major vascular complications [RR 3.58; 95% CI: 1.10-11.61], aortic regurgitation/PVL [RR 6.91; 95% CI: 2.66-17.97], and pacemaker implantation (RR 2.87; 95% CI: 1.74-4.75]. TAVI significantly improved the incidence of prosthesis patient mismatch [RR 0.70; 95% CI: 0.54-0.89], effective orifice valve area (EOA) [MD 0.10; 95% CI: 0.01-0.19], and length of stay in hospital [MD -4.88; 95% CI: -5.52 to -4.23]. There were no significant differences in other clinical or echocardiographic outcomes.

Conclusions: TAVI was associated with higher long-term all-cause mortality compared to SAVR in the overall population. Among patients with small aortic annulus, no survival benefit was observed with TAVI, and cardiovascular mortality was significantly increased. Future RCTs should explore SAA-related outcomes with standardized diagnostic criteria.

Systematic review registration: https://www.crd.york.ac.uk, PROSPERO CRD42024541862.

Keywords: SAVR; TAVI; TAVR—transcatheter aortic valve replacement; small aortic annulus; transcatheter and surgical aortic valve replacement.

PubMed Disclaimer

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
PRISMA 2020 flow chart of included and excluded trials. PRISMA, preferred reporting items for systematic reviews and meta-analyses.
Figure 2
Figure 2
Incidence of all-cause mortality at 3 to 5-year follow-up (TAVI vs. SAVR).
Figure 3
Figure 3
Incidence of all-cause mortality in patients with SAA (TAVI vs. SAVR).
Figure 4
Figure 4
Incidence of stroke at 3 to 5-year follow-up (TAVI vs. SAVR).
Figure 5
Figure 5
Incidence of stroke in patients with SAA (TAVI vs. SAVR).
See this image and copyright information in PMC

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References

    1. Goody PR, Hosen MR, Christmann D, Niepmann ST, Zietzer A, Adam M, et al. Aortic valve stenosis. Arterioscler Thromb Vasc Biol. (2020) 40(4):885–900. 10.1161/ATVBAHA.119.313067 - DOI - PubMed
    1. Zile MR, Gaasch WH. Heart failure in aortic stenosis — improving diagnosis and treatment. N Engl J Med. (2003) 348(18):1735–6. 10.1056/NEJMp030035 - DOI - PubMed
    1. Mancusi C, Bahlmann E, Basile C, Gerdts E. New evidence about aortic valve stenosis and cardiovascular hemodynamics. High Blood Press Cardiovasc Prev. (2022) 29(3):231–7. 10.1007/s40292-022-00520-x - DOI - PMC - PubMed
    1. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. (2021) 77(4):e25–e197. 10.1016/j.jacc.2020.11.018 - DOI - PubMed
    1. Baron SJ, Arnold SV, Wang K, Magnuson EA, Chinnakondepali K, Makkar R, et al. Health status benefits of transcatheter vs. surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial. JAMA Cardiol. (2017) 2(8):837–45. 10.1001/jamacardio.2017.2039 - DOI - PMC - PubMed

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