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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparative effectiveness of transcatheter vs surgical aortic valve replacement: A systematic review and meta-analysis
Iman Moradi, Muhammad Saqlain Mustafa, Jannat Sardar Sheikh, Behrooz Shojai Rahnama, Matthew Fredericks, Anil Kumar Yennam, Mustafa Arain, Utsow Saha, Andrew Richard Ma, Adithya Nagendran, Moosa Bin Omer, Muhammad Armaghan, Diana Carolina Cortés Jaimes, Nagavenkata Lova Surya Vamsi Avinash Bojanki, Muhammad Ashir Shafique
Iman Moradi, Behrooz Shojai Rahnama, Matthew Fredericks, Andrew Richard Ma, Department of Medicine, Saint George's University, Grenada 0000, Grenada
Muhammad Saqlain Mustafa, Muhammad Ashir Shafique, Department of Medicine, Jinnah Sindh Medical University, Karachi 75510, Sindh, Pakistan
Jannat Sardar Sheikh, Moosa Bin Omer, Muhammad Armaghan, Department of Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore 54810, Punjab, Pakistan
Anil Kumar Yennam, Department of Medicine, Emilio Aguinaldo College, Manila 4100, Philippines
Mustafa Arain, Department of Medicine, Dow University of Health Sciences, Karachi 75500, Pakistan
Utsow Saha, Department of Medicine, Icahn School of Medicine at Mount Sinai Queens, New York, NY 11432, United States
Adithya Nagendran, Department of Medicine, Rochester Regional Health-Unity Hospital, Rochester, NY 14617, United States
Diana Carolina Cortés Jaimes, Department of Medicine, Xavierian Pontifical University, Bogota 11023, Colombia
Nagavenkata Lova Surya Vamsi Avinash Bojanki, Department of Medicine, Dr. NTR University of Health Sciences, Andha Pradesh 520008, India
Author contributions: Moradi I, Mustafa MS, Sheikh JS, Rahnama BS, Fredericks M, and Nagendran A conceptualized the study; Mustafa MS and Moradi I administered the project; Mustafa MS validated the research; Kumar Yennam A and Bojanki NLSVA conducted the formal analysis; Arain M curated the data and reviewed and edited the manuscript; Saha U and Ma AR curated the data and conducted the investigation; Bin Omer M and Armaghan M developed the methodology; Cortes Jaimes DC curated the data; Moradi I, Mustafa MS, Sheikh JS, Rahnama BS, Fredericks M, Kumar Yennam A, Arain M, Saha U, Ma AR, Nagendran A, Bin Omer M, Armaghan M, Cortes Jaimes DC, Bojanki NLSVA, and Shafique MA wrote the original draft; Mustafa MS, Shafique MA and Moradi I reviewed and edited the manuscript. All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Muhammad Saqlain Mustafa, MD, Senior Researcher, Department of Medicine, Jinnah Sindh Medical University, Rafiqui Shaheed Road, Karachi 75510, Sindh, Pakistan.
msaqlain.mustafa@gmail.com
Received: December 12, 2024
Revised: March 14, 2025
Accepted: March 28, 2025
Published online: April 26, 2025
Processing time: 130 Days and 11.2 Hours
BACKGROUND
The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement (TAVR), offering a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, the comparative safety and efficacy of these interventions remain subjects of ongoing investigation.
AIM
To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.
METHODS
A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) comparing TAVR and SAVR were identified from databases including PubMed, Scopus, and Web of Science up to May 31, 2024. Data were extracted on clinical outcomes, including mortality, procedural complications, and post-procedure adverse events. Risk ratios (RRs) with 95%CIs were calculated using a random-effects model.
RESULTS
A total of 10 RCTs were included. TAVR demonstrated a significantly lower risk of acute kidney injury (RR: 0.33; 95%CI: 0.25–0.44), major bleeding (RR: 0.37; 95%CI: 0.30–0.46), and new-onset atrial fibrillation (RR: 0.44; 95%CI: 0.34–0.57) compared to SAVR. However, TAVR was associated with higher risks of new permanent pacemaker implantation (RR: 3.49; 95%CI: 2.77–4.39), major vascular complications (RR: 2.47; 95%CI: 1.91–3.21), and paravalvular leaks (RR: 4.15; 95%CI: 3.14–5.48). Mortality at 30 days was comparable (RR: 0.95; 95%CI: 0.78–1.15), but long-term mortality was slightly higher with TAVR in some analyses (RR: 1.23; 95%CI: 1.01–1.49). Rates of stroke (RR: 0.97; 95%CI: 0.81–1.17) and myocardial infarction (RR: 0.91; 95%CI: 0.67–1.24) were similar between the groups.
CONCLUSION
TAVR offers a less invasive option with significant benefits in reducing acute kidney injury, major bleeding, and new-onset atrial fibrillation, making it particularly advantageous for high-risk surgical candidates. However, higher risks of permanent pacemaker implantation, vascular complications, and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
Core Tip: This systematic review and meta-analysis provide a comprehensive comparison of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement in managing severe symptomatic aortic stenosis. TAVR demonstrated significant benefits, including reduced risks of acute kidney injury, major bleeding, and new-onset atrial fibrillation, particularly favoring high-risk surgical candidates. However, higher rates of permanent pacemaker implantation, vascular complications, and paravalvular leaks were observed with TAVR. Mortality and stroke rates were similar between interventions, underscoring the importance of individualized patient selection and shared decision-making to balance risks and optimize clinical outcomes.
