Transcatheter aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials.

Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic valve stenosis (AS) at low risk for surgical aortic valve replacement (SAVR), despite uncertainty regarding medium and long-term clinical outcomes. We performed an updated meta-analysis comparing TAVR with SAVR in this population. We searched PubMed, EMBASE and Cochrane Central for randomized controlled trials (RCT) comparing TAVR with SAVR in low-risk patients with either bicuspid or tricuspid AS. Outcomes of interest were all-cause mortality, rehospitalization and stroke at 30 days, 1 year and up to 5 years follow-up. We included six RCTs with in total 4487 patients, mean age 74.2 ± 5.5y and of which 50.1 % underwent TAVR. The STS-PROM Score was similar for TAVR and SAVR (2.1 ± 0.7 vs. 2.2 ± 0.8 %). Thirty-day all-cause mortality showed a borderline significant difference favoring TAVR (RR 0.55; 95 % CI 0.30-1.01; p = 0.05). One-year all-cause mortality was significantly lower for TAVR (RR 0.60; 95 % CI 0.41-0.98; p = 0.01), while no differences were seen at 5-year follow up (RR 1.02; 95 % CI 0.81-1.29; p = 0.85). TAVR was associated with reduced 30-day (RR 0.67; 95 % CI 0.46-0.95; p = 0.03) and one-year rehospitalization rates (RR 0.72; 95 % CI 0.53-0.98; p = 0.04). Stroke rates at 30 days (RR 0.78; 95 % CI 0.48-1.32; p = 0.37), one-year (RR 0.79; 95 % CI 0.48-1.32; p = 0.37) and 5-year follow-up (RR 1.09; 95 % CI 0.81-1.46; p = 0.56) were not significantly different. TAVR in low-risk patients with AS results in reduced 1-year all-cause mortality and rehospitalization rates as compared with SAVR. This benefit is attenuated during protracted follow-up.