{
  "abstract": "Objectives The comparative long-term safety and efficacy of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) remains under continued investigation, particularly in patients at low- to intermediate-surgical risk. This study aims to synthesise and update contemporary long-term TAVI versus SAVR data.Methods This study comprised a systematic review and meta-analysis and employed a Bayesian hierarchical design. Randomised controlled trials (RCTs) comparing TAVI to SAVR in low-risk to intermediate-risk patients with at least 5-year follow-up were included. The primary outcome was 5-year all-cause mortality; secondary outcomes were the 5-year incidence of stroke and the 5-year incidence of the composite of mortality and stroke.Review methods Time-to-event data were reconstructed. Relative risks (RRs) with 95% credible intervals (CrIs) were estimated from reported 5-year event rates using minimally informative priors. Sensitivity analyses were performed using various meta-analytical models, and using conventional frequentist random-effects and fixed-effects models for sensitivity purposes.Results A total of six RCTs, enrolling 7249 low- to intermediate-risk patients reported 5-year outcomes (TAVI n=3704, SAVR n=3545). The 5-year all-cause mortality rate was 29.7% (28.2–31.2%, TAVI) and 27.6% (26.1–29.1%, SAVR). The median RR for all-cause mortality was 1.12 (95% CrI 1.02–1.22, heterogeneity τ 2=0), with a 99.3% posterior probability that SAVR is superior to TAVI for this endpoint. For stroke, the median RR was 1.13 (95% CrI 0.93–1.39, heterogeneity τ2=0.04), resulting in an 88.0% posterior probability that SAVR outperformed TAVI for this outcome. These results were consistent across conventional frequentist random-effects and fixed-effects models employing p values (RR 1.13, 95% CI 1.05 to 1.22, p=0.001, and RR 1.12, 95% CI 1.03 to 1.23, p=0.011, respectively). There was no evidence for an interaction effect of surgical risk category (p=0.470).Conclusion In this meta-analysis of RCTs, TAVI resulted in a clinically relevant increase in all-cause mortality, and a high probability of an increased risk of stroke, at 5 years of follow-up in low-risk to intermediate-risk patients, when compared to SAVR.",
  "authors": [
    {
      "affiliations": [
        "University Department of Cardiac Surgery, Leipzig Heart Centre University Hospital, Leipzig, SN, Germany"
      ],
      "name": "Mateo Marin-Cuartas"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, LI, The Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands"
      ],
      "name": "Michal J Kawczynski"
    },
    {
      "affiliations": [
        "University Department of Cardiac Surgery, Leipzig Heart Centre University Hospital, Leipzig, SN, Germany",
        "Department of Rhythmology, University Hospital Schleswig Holstein, Kiel, Germany"
      ],
      "name": "Suzanne de Waha"
    },
    {
      "affiliations": [
        "University Department of Cardiac Surgery, Leipzig Heart Centre University Hospital, Leipzig, SN, Germany"
      ],
      "name": "Philipp Kiefer"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany",
        "Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany",
        "DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partner Site Berlin, Berlin, Germany",
        "Department of Health Science and Technology, Translational Cardiovascular Technologies, ETH Zurich, Zürich, Switzerland"
      ],
      "name": "Volkmar Falk"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Bern University Hospital, Bern, Switzerland"
      ],
      "name": "Matthias Siepe"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, Smidt Heart Institute, Los Angeles, California, USA"
      ],
      "name": "Michael E Bowdish"
    },
    {
      "affiliations": [
        "James Cook University Hospital, Middlesbrough, Middlesbrough, UK"
      ],
      "name": "Enoch Akowuah"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium"
      ],
      "name": "Peter Verbrugghe"
    },
    {
      "affiliations": [
        "Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium"
      ],
      "name": "Wouter Oosterlinck"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands"
      ],
      "name": "Robert J M Klautz"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, LI, The Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands"
      ],
      "name": "Roberto Lorusso"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, LI, The Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands"
      ],
      "name": "Elham Bidar"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA"
      ],
      "name": "Mohamed M Rahouma"
    },
    {
      "affiliations": [
        "Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA",
        "Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden",
        "Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden"
      ],
      "name": "Björn Redfors"
    },
    {
      "affiliations": [
        "Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy",
        "Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy"
      ],
      "name": "Giuseppe Biondi-Zoccai"
    },
    {
      "affiliations": [
        "Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York City, New York, USA"
      ],
      "name": "Deepak L Bhatt"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, New York, USA"
      ],
      "name": "Mario Gaudino"
    },
    {
      "affiliations": [
        "University Department of Cardiac Surgery, Leipzig Heart Centre University Hospital, Leipzig, SN, Germany"
      ],
      "name": "Michael A Borger"
    },
    {
      "affiliations": [
        "Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, LI, The Netherlands",
        "Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands"
      ],
      "name": "Samuel Heuts"
    }
  ],
  "title": "Updated 5-year outcomes of transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low- to intermediate-surgical risk",
  "uid": "cb9987b1-ff38-50bb-bdf9-c3e7edfcbb4b"
}