• Babikir Kheiri, Mohammed Osman, Ahmed Bakhit, Qais Radaideh, Mahmoud Barbarawi, Yazan Zayed, Harsh Golwala, Firas Zahr, Gregg W Stone, and Deepak L Bhatt.
• Knight Cardiovascular Institute, Oregon Health & Science University, Portland.
• Am. J. Med. 2020 Feb 1; 133 (2): e38-e41.

PurposeThis study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients.MethodsAn electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model.ResultsFive RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P = .049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P < .01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P < .01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P < .01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P < .01) compared with SAVR.ConclusionAmong older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.Copyright © 2019 Elsevier Inc. All rights reserved.

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