| Abstract [eng] |
ABSTRACT Background: Severe aortic valve stenosis (AS) is considered one of the most common valvular heart diseases, especially in the elderly population, and if left untreated, it is associated with significant mortality and complications. In recent years, transcatheter aortic valve replacement (TAVR) has been introduced as a less invasive method alongside surgical aortic valve replacement (SAVR), and its indications have expanded from high-risk patients to lower-risk groups. Aim: This review aims to compare the clinical outcomes and complication of TAVR and SAVR in patients with AS across different surgical risk groups (high-risk, intermediate-risk and low-risk), based on evidence from randomized controlled trials. Although TAVR was initially indicated for high-risk patients, its use has expanded to include intermediate-risk and low-risk populations. However, differences in clinical outcomes across these risk groups remain incompletely characterized, particularly in terms of short-term and long-term results. This review aims to address this gap by analyzing available evidence and providing a comprehensive comparison across risk categories. Material and Methods: This study was conducted as a systematic clinical evidence-based review primarily focused on randomized controlled trials comparing TAVR and SAVR. A structured literature search was performed in the PubMed database for studies published between 2015 and 2025. A total of 529 studies were initially identified, and 7 randomized controlled trials were included in the final analysis. Data were categorized and analysed based on surgical risk level and follow-up duration (30 days, 1 year, 2 years, 5 years, and 8 years if available). The main outcomes included all- cause mortality, cardiovascular mortality, stroke, myocardial infarction, MACE, bleeding complications, atrial fibrillation, renal outcomes, haemodynamic performance, and valve durability parameters. Results: in high-risk patients, TAVR had outcomes that were similar or in some cases better than SAVR, particularly in the short-term period. In intermediate-risk patients, no significant difference was observed between the two methods in most clinical outcomes. In low-risk patients, TAVR was associated with favourable short-term outcomes; however, these advantages decreased over long- term follow-up, and the outcomes of the two methods converged. In terms of complications, TAVR was associated with a higher rate of permanent pacemaker implantation and paravalvular leak, whereas SAVR was associated with increased bleeding and a higher incidence of postoperative atrial 2 fibrillation. However, although surgical valves are generally considered more durable, the long-term evidence comparing durability between TAVR and SAVR is still limited. Conclusion: TAVR is considered an effective and less invasive option in the treatment of severe AS, especially in elderly and high-risk patients. However, the choice of treatment method should be based on an individualized patient assessment, including surgical risk level, age, life expectancy, anatomical characteristics, and patient preferences, within the framework of multidisciplinary Heart Team decision-making. Keywords: Severe aortic stenosis; transcatheter aortic valve replacement (TAVR); surgical aortic valve replacement (SAVR); clinical outcomes; randomized controlled trials. |
