{
  "abstract": "Introduction Surgical aortic valve replacement (SAVR) has long been the standard treatment for patients with severe aortic stenosis (AS) at low surgical risk. However, transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative. This meta-analysis compares the efficacy and safety of TAVR versus SAVR in low-risk AS patients across different follow-up intervals.Methods A systematic search of PubMed, Embase, and the Cochrane Library was performed through September 2024. Six randomized controlled trials (RCTs) and eight follow-up reports were included (n = 11,953). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model via Revman (Version 5.4.1).Results At 30 days, there was no significant difference in all-cause or cardiovascular mortality between TAVR and SAVR. At 1 year, TAVR significantly reduced all-cause mortality (RR: 0.61; P = 0.0009) ( figure 1) and cardiovascular mortality (RR: 0.62; P = 0.006) (figure 2), with no differences at 2 years or beyond 5 years. Stroke and myocardial infarction rates were comparable at all follow-up points. TAVR markedly reduced new-onset or worsening atrial fibrillation (AF) at 30 days (RR: 0.19; P < 0.00001), 1 year (RR: 0.24; P < 0.00001), 2 years (RR: 0.27; P < 0.00001), and ≥5 years (RR: 0.45; P = 0.001) (figure 3). Major bleeding was significantly lower with TAVR at 30 days (RR: 0.29; P < 0.00001) and 1 year (RR: 0.31; P < 0.00001) (figure 4). In contrast, TAVR increased major vascular complications at 30 days (RR: 2.19; P = 0.05) (figure 5) and permanent pacemaker implantation at 30 days (RR: 2.73; P = 0.002), 1 year (RR: 2.29; P < 0.0001), 2 years (RR: 3.38; P = 0.009), and ≥5 years (RR: 2.19; P = 0.001) (figure 6). Hospitalizations were reduced with TAVR at 30 days (RR: 0.52; P = 0.007) and 1 year (RR: 0.72; P = 0.04), with no long-term difference (figure 7).Conclusion In low-risk AS patients, TAVR offers early benefits, including lower 1-year mortality, bleeding, AF endocarditis and hospitalization, but these advantages wane over time. Higher rates of pacemaker implantation and vascular complications highlight the need to weigh short-term gains against long-term risks when selecting treatment.Abstract 387 Figure 1–3Abstract 387 Figure 4–7Abstract 87 Table 1Concordance between optimistic TMACS risk categories and Trust ManagementT-MACS Risk categoryDischargedObserved (2ndTrop.)Admitted (Acute Med)Admitted (Cardiology)TotalVery low risk (n=24)9 (38%)15 (63%)0 (0%)0 (0%)24 (100%)Low risk (n=7)3 (43%)4 (57%)0 (0%)0 (0%)7 (100%)Moderate risk (n=10)1 (10%)5 (50%)3 (30%)1 (10%)10 (100%)High risk (n=7)1 (14%)0 (0%)2 (29%)4 (57%)7(100%)Unable to calculate (n=2)2(100%)0 (0%)0 (0%)0 (0%)2 (100%)Total (n=50)16 (32%)24 (48%)5 (10%)5 (10%)50 (100%)",
  "authors": [
    {
      "affiliations": [
        "Department of Medicine, Worcestershire Acute Hospital trust, NHS Foundation, Worcestershire, United Kingdom"
      ],
      "name": "Mohsin Nawaz"
    },
    {
      "affiliations": [
        "Department of Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia"
      ],
      "name": "Khadeeja Sirajuddin"
    },
    {
      "affiliations": [
        "Department of Medicine, St. Joseph’s Healthcare Hamilton Charlton Campus, Ontario, Canada"
      ],
      "name": "Moaz Alowami"
    },
    {
      "affiliations": [
        "Department of Medicine, Velindre Cancer Centre, NHS Wales, Cardiff, Wales, United Kingdom"
      ],
      "name": "Khant Nyi Zaya"
    },
    {
      "affiliations": [
        "South Tees NHS Trust, Middlesbrough, United Kingdom"
      ],
      "name": "Thin Ei Hlaing"
    },
    {
      "affiliations": [
        "York Teaching Hospital, York, North Yorkshire, United Kingdom"
      ],
      "name": "Durga Prasad Bhimineni"
    },
    {
      "affiliations": [
        "School of Medicine, University of Jordan, Amman, Jordan"
      ],
      "name": "Malik Alta’amreh"
    },
    {
      "affiliations": [
        "Department of Acute Medicine, Addenbrooke’s Hospital, Cambridge, United Kingdom"
      ],
      "name": "Kevin Vinod Joseph"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, United Lincolnshire NHS Trust, Lincoln, United Kingdom"
      ],
      "name": "Tharun Adithya Natesan"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom"
      ],
      "name": "Talal Warsi"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Saudi German Hospital, Dubai, United Arab Emirates"
      ],
      "name": "Ahmed Eid Ahmed Abouayana"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Tabish Pathan"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Aya Abouayana"
    },
    {
      "affiliations": [
        "Department of Neurology, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom"
      ],
      "name": "Lilia Megherbi"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates"
      ],
      "name": "Eman Ibrahim Elzain Hassan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Somerset NHS Foundation Trust, Taunton, United Kingdom"
      ],
      "name": "Nitish Behary Paray"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal"
      ],
      "name": "Rukesh Yadav"
    },
    {
      "affiliations": [
        "Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan"
      ],
      "name": "Maryam Shahzad"
    },
    {
      "affiliations": [
        "Department of Medicine, Imperial College London, London, United Kingdom"
      ],
      "name": "Ali Hasan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Royal Brompton Hospital, London, United Kingdom"
      ],
      "name": "Raheel Ahmed"
    }
  ],
  "title": "387 Temporal trends in outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in low-risk patients with aortic stenosis: a meta-analysis of randomized controlled trials",
  "uid": "e683514e-f194-5453-8b05-0409c1d47ef4"
}