Longer-term and Landmark Analysis of Transcatheter versus Surgical Aortic-Valve Implantation in Severe Aortic Stenosis: A Meta-Analysis

Yu Wang Xiaowen Zhang Xinlin Zhang ^* Wei Xu ^*

• Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

Background: Previous reports of longer-term outcomes of transcatheter aortic valve implantation (TAVI) focus on higher risk patients and suggest potential temporal changes.To evaluate the longer-term and temporal performances of TAVI compared to surgical aortic valve replacement (SAVR).Methods: Randomized controlled trials reporting outcomes with at least 1-year follow-up. The primary outcome was the composite of all-cause death or disabling stroke.We included 8 trials with 8,749 patients. TAVI was associated with a higher risk of longer-term (5-year) primary outcome compared to SAVR among higher-risk (odds ratio [OR], 1.25; 95% CI, 1.07-1.47) but not lower-risk participants (1.0 [0.77-1.29]). However, a significant temporal interaction was detected in both risk profiles. TAVI with balloonexpandable valves was associated with a higher risk of longer-term primary outcome compared to SAVR (1.38 [1.2-1.6]), whereas no statistical difference was found with selfexpanding valves (1.03 [0.89-1.19]). There was a significant interaction between the two valve systems, and a temporal interaction was detected in both systems. Overall landmark analysis revealed a lower risk in TAVI within the initial 30 days (0.76 [0.6, 0.96]), comparable between 30 days to 2 years (1.04 [0.85, 1.28]), and higher beyond 2 years (1.36 [1.15-1.61]). Analysis for all-cause death generated largely similar results.Conclusions: TAVI was associated with a higher longer-term risk of primary outcome compared to SAVR in higher-risk patients and with balloon-expandable valves. However, a characteristic temporal interaction was documented in all subgroups. Future studies are warranted to test these findings.