• Babikir Kheiri, Mohammed Osman, Hossam Abubakar, Ahmed Subahi, Adam Chahine, Sahar Ahmed, Ghassan Bachuwa, Mohammad L Alkotob, Mustafa Hassan, and Deepak L Bhatt.
• Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA.
• Cardiovasc Revasc Med. 2019 Oct 1; 20 (10): 838-842.

BackgroundTranscatheter aortic valve replacement (TAVR) is a valid option for patients with high or intermediate surgical risk. However, clinical outcomes of TAVR in low-risk patients are lacking. Our aim was to evaluate the efficacy and safety of TAVR versus surgical aortic valve replacement (SAVR) in low-surgical-risk patients.MethodsElectronic database review was conducted for all randomized clinical trials (RCTs) that compared TAVR versus SAVR in low-risk patients. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.ResultsWe included 3 RCTs totaling 604 patients (310 TAVR and 294 SAVR). Our results showed no significant difference in mortality between TAVR compared with SAVR (RR = 0.71; 95% CI = 0.22-2.30; P = 0.56), however, there was a significantly increased risk of pacemaker implantation (RR = 7.28; 95% CI = 3.94-13.42; P < 0.01) and moderate/severe paravalvular leakage (PVL) (RR = 6.74; 95% CI = 1.31-34.65; P = 0.02) with TAVR. Nevertheless, TAVR demonstrated a significantly reduced risk of post-procedural bleeding (RR = 0.40; 95% CI = 0.30-0.54; P < 0.01) and new-onset atrial fibrillation (RR = 0.36; 95% CI = 0.27-0.47; P < 0.01). Other clinical outcomes were not significantly different between the groups and included cardiovascular mortality, stroke, transient ischemic attack, and myocardial infarction.ConclusionsAmong low-risk patients, TAVR offered comparable efficacy outcomes and fewer bleeding events compared with SAVR. There were increased risks of pacemaker implantation and PVL associated with TAVR, though lower atrial fibrillation risks.Copyright © 2018 Elsevier Inc. All rights reserved.

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