Photo Credit: freepik

The following is a summary of “Midterm Survival of Low‐Risk Patients Treated With Transcatheter Versus Surgical Aortic Valve Replacement: Meta‐Analysis of Reconstructed Time‐to‐Event Data,” published in the October 2023 issue of Cardiology by Sá et al.

The researchers conducted a comprehensive meta-analysis using reconstructed time-to-event data from randomized controlled trials (RCTs) and propensity-score matched (PSM) studies to compare the outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in patients deemed low risk for SAVR. Involving eight studies (3 RCTs and 5 PSM studies) with a total of 5,444 patients, of which 2639 underwent TAVR and 2,805 SAVR, their analysis revealed that TAVR presented a higher risk of all-cause mortality at an 8-year follow-up (hazard ratio [HR] 1.22, [95% CI, 1.03–1.43], P=0.018). Up to a 2-year follow-up, TAVR showed no inferiority to SAVR (HR, 1.08 [95% CI, 0.89–1.31], P=0.448). 

However, beyond 2 years, a significant difference emerged, indicating higher mortality associated with TAVR (HR, 1.51 [95% CI, 1.14–2.00]; P=0.004). This difference was mainly observed in PSM studies, where sensitivity analysis demonstrated a statistically significant disparity between TAVR and SAVR (HR, 1.41 [95% CI, 1.16–1.72], P=0.001), whereas no significant difference was evident in RCTs alone (HR, 0.89 [95% CI, 0.69–1.16], P=0.398). Their findings suggest that SAVR may be linked to better survival beyond 2 years in low-risk patients, albeit this benefit was predominantly observed in PSM studies rather than RCTs. 

Future research should encompass data from ongoing RCTs and extend follow-up periods in previous RCTs to ascertain if there exists a substantial disparity in mid- and long-term survival between TAVR versus SAVR within the low-risk population.

Source: ahajournals.org/doi/10.1161/JAHA.123.030012