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February 2, 2026Srce i krvni sudovi0 citationsOpen Access

TAVI in the lights of new ESC guidelines and randomized clinical trials

MNMilan NedeljkovićDRDušan RužičićVMVladimir Mitov

Key Result

TAVI is associated with a significantly lower rate of the primary composite endpoint compared to SAVR in patients with low surgical risk.

Key Points

  • This research aims to assess the implications of new ESC guidelines and recent clinical trials on the use of TAVI in treating aortic stenosis.
  • Review of ESC guidelines regarding aortic stenosis treatment modalities.
  • Analysis of randomized clinical trials, including PARTNER 3, Evolut Low Risk, and NOTION studies.
  • Comparison of TAVI and SAVR outcomes based on operative risk assessments.
  • TAVI is recommended for elderly patients (≥75 years) and those at high operative risk (>8% STS-PROM/EuroScore II).
  • Recent studies show TAVI is safe for patients with low operative risk (<4% STS-PROM/EuroScore II).
  • TAVI demonstrates non-inferiority to SAVR in clinical outcomes for low-risk patients.

Structured PICO

Does TAVI provide safe and non-inferior outcomes compared to SAVR in patients with aortic stenosis across different surgical risk profiles?

P
Population
Patients with aortic stenosis
I
Intervention
Transcatheter aortic valve implantation (TAVI)
C
Comparator
Surgical aortic valve replacement (SAVR)

This review highlights that recent large RCTs support the safety and non-inferiority of TAVI compared to SAVR even in low-risk patients, influencing current ESC guidelines.

Main Result

Effect estimate: HR 0.54 (95% CI 0.37-0.79)

Absolute Event Rate: 8.5% vs 15.1%

p-value: p=<0.001

Limitations

  • Study is a review, with various RCTs referenced rather than presenting new clinical data.

Abstract

Aortic stenosis (AS) is the most common valvular disease requiring surgical (SAVR) or transcatheter intervention (TAVI) in Europe and North America. The first TAVI was performed in 2002 in order to find clinical application in a short period of time, and the initial ESC guidelines recommended this procedure in patients with a high risk of SAVR. ESC guidelines for the treatment of valvular diseases from 2021, the decision on the treatment modality of AS is defined by the Heart team, and SAVR is recommended in younger patients with a low risk of surgery (75 years STS-PROM/EuroScore II4%), and TAVI is recommended in elderly patients ≥75 years or in patients with high operative risk (STSPROM/EuroScore II8%) or in patients not suitable for surgery. On the other hand, large randomized clinical studies (The PARTNER 3, Evolut Low Risk and NOTION studies) showed that TAVI is safe even for patients with a low operative risk (STS-PROM/EuroScore II4%) and that it is not inferior to SAVR (UK TAVI trial).

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Cite This Study

Nedeljković et al. (2022) conducted a review in Aortic Stenosis (AS). Transcatheter Aortic Valve Implantation (TAVI) vs. Surgical Aortic Valve Replacement (SAVR) was evaluated on Composite of death, stroke, or rehospitalization at 1 year (HR 0.54, 95% CI 0.37-0.79, p=<0.001). TAVI is associated with a significantly lower rate of the primary composite endpoint compared to SAVR in patients with low surgical risk.

synapsesocial.com/papers/6980fefbc1c9540dea81194bhttps://doi.org/10.5937/siks2203061n
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery2010 · 7,226 citations
  2. 2Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis2019 · 281 citations
  3. 3Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement2020 · 838 citations
  4. 4Cost-Effectiveness of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis at Intermediate Risk2019 · 182 citations
  5. 5Five-Year Clinical and Echocardiographic Outcomes From the NOTION Randomized Clinical Trial in Patients at Lower Surgical Risk2019 · 331 citations