• Fang Fang, Jingjing Tang, Yaqin Zhao, Jialing He, Ping Xu, and Andrew Faramand.
• West China Hospital, Sichuan University, Chengdu, Sichuan, China.
• Plos One. 2019 Jan 1; 14 (9): e0221922.

BackgroundTranscatheter aortic valve implantation (TAVI) is an option for treatment for patients with severe aortic stenosis who are at high risk for death with surgical aortic valve replacement (SAVR). It is unknown whether TAVI can be safely introduced to intermediate- and low-risk patients.ObjectiveTo compare the efficacy and safety of TAVI and SAVR in patients with intermediate- and low-surgical risk.Data SourcesMedline, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to April 15, 2019.Study SelectionWe included randomized controlled trials comparing TAVI with SAVR in patients with intermediate- and low-surgical risk.Data ExtractionMeta-analyses were conducted using random-effects models to calculate risk ratios (RR) with corresponding 95% confidence interval (CI). Two independent reviewers completed citation screening, data abstraction, and risk assessment. Primary outcome was a composite of all-cause mortality or disabling stroke at 12 months.Data SynthesisA total of 5 trials randomizing 6390 patients were included. In patients with low risk, TAVI was associated with a significant reduction in the composite of all-cause mortality or disabling stroke compared with SAVR (RR, 0.56; 95%CI, 0.40-0.79; I2 = 0%). This benefit was not replicated in patients with intermediate risk (RR, 0.96; 95% CI, 0.80-1.15; I2 = 0%). Similar results were seen separately in all-cause mortality and disabling stroke when TAVI was compared with SAVR.ConclusionFor patients with severe aortic stenosis who were at low risk for death from surgery, TAVI achieved superior clinical outcomes compared to SAVR; however, these benefits were not seen in those with intermediate risk. This information may inform discussions about deciding between SAVR and TAVI for patients with low to intermediate risk separately.

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