Introduction
Aortic stenosis (AS) is a common heart valve disorder in the elderly with increasing incidence in the ageing population.[1] Currently, there is no effective therapy for this condition, as valve replacement is the standard of care. Historically, surgical aortic valve replacement (SAVR) is regarded as the gold standard for patients with severe AS. [2]As a novel modality, transcatheter aortic valve implantation (TAVI) has garnered significant support for its use over the years since its first application in 2002[3], and it is currently the best alternative to SAVR in high-risk surgical patients with AS.[4]
The PARTNER Ⅱ trial shows that the efficacy of TAVI is non-inferior to that of SAVR[5] in intermediate-risk patients with AS, prompting the American College of Cardiology to recommend TAVI for intermediate-risk patients (class IIa).[6]However, complications due to TAVI, such as paravalvular leakage and durability, are still a cause for concern.[7]Industry experts are in discussion on whether TAVI can be widely used in low-risk surgical patients with AS. Several randomised controlled trials (RCTs) have been conducted on this matter [8,9], but the results from these experiments and meta-analyses are not consistent. The latest 2020 guidelines still list SAVR only as a class I treatment for low-risk surgical patients without recommending TAVI in this patient subset.[10] The two-year follow-up results published in the PARTNER III study[11] (by Martin et al.) did provide some evidence to suggest that further investigation of the efficacy of TAVI versus that of SAVR in low-risk surgical patients with AS would be prudent. As a result, we conducted a new meta-analysis to compare TAVI with SAVR to clearly delineate their performance based on different time frames and patient risk stratification.