Abstract Body (Do not enter title and authors here): Background: There is limited data on long-term outcomes after transcatheter aortic valve
replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with low surgical
risk.
Research Questions: This study aims to investigate the trends in outcomes after TAVR versus
SAVR in patients with severe aortic stenosis and low surgical risk during extended follow-up
intervals.
Methods: Electronic databases were systematically searched until April 2024 for randomized
clinical trials (RCTs) comparing TAVR versus SAVR in patients with an STS-PROM score <4%.
The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular
mortality, stroke, disabling stroke, rehospitalization, myocardial infarction, aortic valve
reintervention, permanent pacemaker implantation (PPI), and new-onset atrial fibrillation
(NOAF). Random-effect models were utilized to analyze the risk of each outcome at different
follow-up intervals.
Results: This meta-analysis included 5 RCTs, including 4,301 patients. TAVR was associated
with a significantly lower risk of all-cause mortality during 30 days (HR: 0.56, 95%CI: 0.32-
0.98) and 30 days to 1 year (HR: 0.47, 95%CI: 0.31-0.72) post-procedural follow-ups compared
to SAVR. However, the risk of all-cause mortality during extended follow-ups became
comparable between the two interventions (HR: 1.03, 95%CI: 0.71-1.50). In secondary
outcomes, TAVR was associated with a lower risk of cardiovascular mortality, disabling stroke,
NOAF, and a higher risk of PPI compared to SAVR in both the 30-day and 1-year follow-ups.

Notably, only the risks of NOAF and PPI remained significant during extended follow-ups.
Comparable risks were noted between TAVR and SAVR for the remaining outcomes in different
follow-ups.
Conclusion: TAVR was associated with a lower risk of all-cause mortality during the initial 30-
days and 1-year follow-ups compared to SAVR in low-surgical risk patients. However, a
convergence in the risk of all-cause mortality was observed after the first year. Further studies are
needed to determine strategies to improve long-term outcomes following aortic valve
interventions.