Cochrane corner: transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk

Aortic valve stenosis (AS) is a growing health problem worldwide, especially in elderly populations.1 Its severity is classified by a number of clinical and echocardiographic parameters into mild, moderate and severe AS. The latter, if left untreated, can be deleterious to the affected individuals’ quality of life and may ultimately be fatal.1 Clinical manifestations of severe AS include exertional dyspnoea, chest pain and syncope.1 Surgical aortic valve replacement (SAVR) has long been the classical treatment modality for severe, symptomatic AS. SAVR has been proven to alleviate symptoms and prolong survival, rendering it the standard of care.2 In the current era, with the rapidly evolving technology and growing momentum towards minimally invasive procedures, transcatheter aortic valve implantation (TAVI) has emerged as a viable, alternative treatment option.3 TAVI has demonstrated outcomes comparable to SAVR in patients who are deemed inoperable or at a high to intermediate surgical risk.2 Nonetheless, whether TAVI improves outcomes in patients who are deemed to have a low surgical risk remains a matter of debate. Accordingly, in our Cochrane review,4 we sought to assess the comparative outcomes of TAVI and SAVR for severe AS in people with low surgical risk. We conducted an exhaustive literature search for randomised controlled trials (RCTs) comparing TAVI and SAVR for severe AS in patients with low surgical risk. We included adults (≥18 years old) of both sexes. The low surgical risk was defined as a Society of Thoracic Surgery (STS) risk score or European System for Cardiac Operative Risk Evaluation (EuroSCORE) II of