Abstract

While surgical aortic valve replacement (SAVR) remains the gold standard for severe aortic stenosis (SAS), concerns about peri- and post-operative stroke, bleeding, and mortality persisted. Transcatheter aortic valve implantation (TAVI), known for reducing surgical complications and improving survival in high-risk patients, faces implementation barriers due to system readiness, antecedents, and poor communication among cardi ologists and cardiac surgeons. This study aimed to compare the TAVI and SAVR in SAS patients across different surgical risk categories, focusing on efficacy, safety, procedural outcomes, long-term survival, and quality of life. A systematic review and meta-analysis were conducted through extensive research of studies published in June 2023 without time frame limitations, was conducted in key databases such as MEDLINE, Cochrane, and EMBASE. Search terms, including ‘TAVI’, ‘SAVR’, Aortic valve stenosis’, and other relevant synonyms, were employed. Statistical analysis was conducted using Review Manager. The search yielded 19 randomized con trolled trials with 11,091 TAVI and 10,606 SAVR patients. Mortality was similar (OR = 0.96, 95% CI 0.84-1.09, p = 0.51). Cardiovascular mortality demonstrated statistical significance at the 5-year follow-up (OR = 1.17, 95% CI 1.02-1.36, p = 0.03); however, when assessed over the entire study duration, the association was not statistically significant (OR = 1.00, 95% CI 0.89-1.13, p = 0.96). Stroke rates showed no significant difference (OR = 0.85, 95% CI 0.55-1.3, p = 0.45). TAVI and SAVR showed similar mortality. TAVI might reduce major bleeding and kidney injury, but has more pacemaker needs and re-hospitalizations.

Key words: Transcatheter Aortic Valve Implantation (TAVI), Surgical Aortic Valve Replacement (SAV