TAVR or SAVR? What can we learn from a pooled meta-analysis of reconstructed time to event data?

Randomized clinical trials (RCTs) have compared transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for the treatment of severe aortic valve stenosis in high-risk, intermediate-risk and low-risk patients since TAVR became clinically available. The results supported a stepwise expansion of the indication for TAVR from high-risk patients to intermediate-risk patients to low-risk patients. Consequently, the 2021 guidelines for the management of patients with valvular heart disease from the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have been revised and now give a class I recommendation for TAVR for patients ≥75 years old regardless of additional comorbidities [1]. The 2020 American College of Cardiology/American Heart Association guideline for the management of patients with valvular heart disease even gives a class I recommendation for transfemoral TAVR for patients ≥65 years old after interdisciplinary patient assessment considering patient longevity and valve durability