Transcatheter Aortic Valve Replacement in Low-Risk Patients at Four or More Years.

Transcatheter aortic valve replacement (TAVR) is accepted as an alternative to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic valve stenosis (AS). Prior studies have shown TAVR has comparable or superior outcomes to SAVR in intermediate and high-risk patients. However, there is paucity of data about outcome of TAVR versus SAVR in low surgical risk patients evaluated at 4 or more years post-procedure. A systematic review of all published randomized controlled trials comparing TAVR and SAVR in patients at low-risk patients was completed. A random-effects model meta-analysis was performed to study major outcomes including all-cause mortality, stroke, myocardial infarction, and aortic valve re-intervention. 3 randomized trials comprising 2,644 patients (1,371 TAVR and 1,273 SAVR) with mean age of 74.3 ± 5.8 were included in this analysis. There was no significant difference in all-cause and cardiovascular mortality, stroke, myocardial infarction, and aortic valve reintervention between TAVR and SAVR groups at long-term follow up. TAVR was associated with higher rate of pacemaker implantation, while SAVR was associated with more atrial fibrillation. At 4 or more years of follow-up, TAVR is safe and has comparable outcomes to SAVR in patients with low surgical risk. Possibility of TAVR and its risks and benefits should be discussed with patients with low surgical risk.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jon Resar reports grants to the institution from Medtronic for pivotal TAVR studies for which he is a principal investigator. The remaining authors have no disclosures to report.