TRANSCATHETER aortic valve implantation (TAVI) results in an increase in all-cause mortality, and a high probability of an increased risk of stroke, at 5 years follow-up when compared to surgical aortic valve replacement (SAVR), a 2026 systematic review and meta-analysis has found.
The study analysed patients with severe aortic stenosis at low- to intermediate-surgical risk.
Use of Transcatheter Aortic Valve Implantation
Historically used as a palliative option for inoperable patients or a standard alternative to SAVR in higher-risk populations, TAVI is now applied to low- and intermediate-risk populations following landmark randomised controlled trials (RCT).
Concern persists regarding the potential long-term outcomes of TAVI, particularly as it is increasingly performed in younger patients with longer life expectancies.
Surgical Aortic Valve Replacement Superiority
A total of six RCTs were included, reporting 5-year outcomes, with more than 7,200 patients presenting with severe symptomatic aortic valve stenosis at low- to intermediate-surgical risk.
The 5-year all-cause mortality rate was 29.7% for TAVI and 27.6% for SAVR. There was a more than 99% probability that SAVR is superior to TAVI for overall survival at 5 years, and 88% probability that it is superior for stroke risk at 5 years.
SAVR is therefore associated with superior long-term survival and a high probability of reduced likelihood of stroke.
The comparison between TAVI and SAVR was consistent across low- and intermediate-surgical risk groups.
Heterogeneity and Valve Types
Since the analysis only included six RCTs, generalisability may be limited. Out of included trials, there was substantial heterogeneity across valve technology, procedural approach and patient characteristics. This may confound valve-specific differences in long-term outcomes.
More recent trials used modern TAVI valve types, whilst older trials used more historical TAVI valves, which might also have influenced outcomes. Although, a meta-regression provided no supporting evidence. The analysis also focused on mortality and stroke, whilst there are other indicators of valve performance and patient quality of life.
Transcatheter Aortic Valve Implantation in Younger Populations
Researchers emphasised that TAVI remains an important patient option, particularly for those with high-surgical risk. However, findings challenged the increased use of TAVI in younger and lower-risk populations with longer life expectancies.
Reference
Marin-Cuartas M et al. Updated 5-year outcomes of transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low- to intermediate-surgical risk. Heart. 2026;0:1-9.
