Meta-Analysis of Large TAVR Studies on Low-Risk: Evidence is Consistent

This meta-analysis which included the 4 large randomized studies on transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in low-risk patients recently published in JACC, showed TAVR is associated with significant lower mortality compared against SAVR at one year follow up. 

These results add to the mounting evidence showing that when it comes to patients that need a bioprosthetic valve replacement, the whole risk spectrum can be treated with TAVR instead of SAVR. 

The 4 randomized studies (NOTION, Surtavi, Evolut low risk and Partner 3) were chosen because they include patients with STS <4%. Primary end -point was all cause mortality at one year.

In all, 2887 patients were randomized (1497 for TAVR and 1390 for SAVR) with mean age 75.4 and mean STS-PROM of 2.3%.

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Compared to SAVR, TAVR was associated with significant lower risk of all cause death (2.1% vs. 3.5%; RR: 0.61; CI 95%: 0.39 to 0.96; p=0.03) and cardiovascular death (1.6% vs. 2.9%; RR: 0.55; CI 95%: 0.33 to 0.90; p=0.02) at one year.

The rates of new atrial fibrillation, life threatening bleeding and acute kidney failure were higher with SAVR, while pacemaker implantation and moderate to severe paravalvular leak rates were higher with TAVR.

There were no significant differences between the strategies in major vascular complications, endocarditis, reintervention and post procedural functional class. 

Conclusion

This meta-analysis of the large randomized studies comparing TAVR against SAVR showed that TAVR presents significant lower all-cause mortality at one year. These results support the idea that TAVR might always be the best strategy, regardless of risk, in patients with severe aortic stenosis in need of a bioprosthetic aortic valve replacement. 

Original Title: Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients.

Reference: Dhaval Kolte et al. J Am Coll Cardiol 2019;74:1532–40.

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