A meta-analysis reveals that patients with severe, symptomatic aortic stenosis (AS) who are low or intermediate surgical risk can safely undergo transcatheter aortic valve implantation (TAVI) as an alternative to surgery. Sebastian Ludwig, MD, from the University Heart and Vascular Center Hamburg, Germany, presented these results during a Late-Breaking Clinical Science session at the European Society of Cardiology (ESC) Congress 2025 in August. Data were also simultaneously published in JAMA: Cardiology. Patients with severe AS who are at lower risk for surgery may benefit from TAVI over surgical aortic valve replacement (SAVR), but data from randomized clinical trials (RCTs) have yet to be pooled to apply these results to everyday medical practice. The investigators in this meta-analysis compared TAVI versus SAVR at 1-year follow-up in patients with AS who were low to intermediate risk for surgery. A 2-stage individual participant data (IPD) and aggregate meta-analyses were performed to get the results. RCTs from MEDLINE databases were used in the analyses. The RCTs compared TAVI and SAVR up through June 15, 2025. The 4 RCTs included on the IPD level, all investigator-initiated, were DEDICATE, UK TAVI, NOTION and NOTION-2. Additionally, industry-sponsored RCTs were used for the overall meta-analysis for aggregate data. All-cause death or stroke 1-year after randomization was the primary endpoint of this meta-analysis. The investigators also noted several secondary endpoints: all-cause death, stroke, disabling stroke, cardiovascular death, rehospitalization for cardiovascular reasons, myocardial infarction, new-onset atrial fibrillation, new permanent pacemaker implantation and aortic valve reintervention. The 4 RCTs utilized had a total sum of 2,873 patients (mean age=76.7 years, 56.1% male) who were randomly assigned to TAVI (n=1,439) or SAVR (n=1,434). At the 1-year follow-up, the primary endpoint hazard ratio (HR) was 0.73 for TAVI compared with SAVR (95% confidence interval [CI]=0.56-0.95) for the 1-stage IPD meta-analysis. The 2-stage IPD meta-analysis showed an HR of 0.79 (95% CI=0.49-1.27) in TAVI versus SAVR patients. The 2-stage overall meta-analysis HR was 0.76 (95% CI=0.60-0.97) for the primary endpoint. Overall, TAVI is a suitable treatment option in low to intermediate risk patients with severe AS. Source: Ludwig S, Klimek M, Bay B, et al. Transcatheter or surgical treatment of patients with aortic stenosis at low to intermediate risk. JAMA. 2025 August (Article in press). Image Credit: Pepermpron – stock.adobe.com