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.