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Comparative analysis of early stroke riskin transcatheter versus surgical aortic valve replacementin elderly patients
Date
2026-04-16
Abstract
Background and Aims Transcatheter aortic valve replacement (TAVR) is an innovative treatment option for patients with severe symptomatic aortic stenosis. However, an analysis of cerebrovascular risk post-TAVR compared to surgical aortic valve replacement (SAVR) in elderly patients has not been established. Methods We performed a systematic review and meta-analysis of randomised controlled trials and observational studies by conducting a comprehensive literature search in multiple digital databases to compare the 30-day and 1-year cerebrovascular risk in elderly patients undergoing TAVR or SAVR. Results Our search yielded 12 studies with a total of 12,457 patients, with 7247 and 5210 in the TAVR and SAVR groups, respectively. A statistically significant reduction in cerebrovascular risk was observed at the 30-day follow-up for patients undergoing TAVR compared to SAVR (OR 0.74; 95% CI 0.55–0.99; p = 0.02, N = 12,231). Likewise, at the 1-year follow-up, TAVR demonstrated a statistically significant reduction in cerebrovascular risk compared to SAVR (OR 0.77; 95% CI 0.62–0.96; p = 0.02, N = 12,457). Meta-regression analysis revealed that prior myocardial infarction, prior percutaneous coronary intervention and a pre-existing pacemaker were associated with attenuation of the stroke risk advantage of TAVR at 30 days post-op. Similarly, prior myocardial infarction and pre-existing pacemakers were identified as risk factors at 1 year. Conclusion This review and meta-analysis highlight the significant difference in the risk of cerebrovascular events between TAVR and SAVR. However, pre-existing conditions modify these differences, underscoring the necessity of patient selection and risk stratification to optimise clinical outcomes.
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Publisher
John Wiley & Sons Ltd
Citation
Journal of Interventional Cardiology 5850249
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Sustainable Development Goals
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Attribution-NonCommercial-ShareAlike 4.0 International