Transcatheter versus Surgical Aortic Valve Replacement in Low-Risk Patients: Meta-Analysis of 30-Day Perioperative Stroke Risk

Background Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) for low-risk patients with severe aortic stenosis. Given that perioperative stroke, defined as any ischemic or hemorrhagic stroke confirmed by imaging or clinical diagnosis within 30 days post-procedure—remains a critical adverse event affecting both short- and long-term outcomes, a rigorous comparative evaluation of stroke risk between these modalities is warranted. Methods A comprehensive literature search of MEDLINE (PubMed), and ScienceDirect was conducted from inception to November 2024 to identify relevant randomized controlled trials (RCTs) comparing TAVR with SAVR in low-risk patients. Six RCTs met the inclusion criteria. The primary endpoint was the 30-day perioperative stroke rate. For studies with zero events, a continuity correction of 0.5 was applied. Heterogeneity was assessed via Tau², Chi², and I² statistics, and a prediction interval was computed. Results The pooled analysis of six RCTs revealed a hazard ratio of 0.76 (95% CI: 0.55–1.06, p = 0.10), indicating a non-significant trend toward a lower risk of perioperative stroke with TAVR compared to SAVR. Heterogeneity was low (I² = 14%; Tau² = 0.0244; Chi² = 5.79, p = 0.33), with a prediction interval of 0.41 to 1.44. Conclusion In this meta-analysis of six RCTs, TAVR demonstrated a modest, non-significant trend toward reduced perioperative stroke risk compared to SAVR in low-risk patients. While the findings suggest potential benefits of TAVR regarding stroke prevention, the lack of statistical significance underscores the need for further studies with extended follow-up and additional clinical endpoints to refine patient selection and optimize treatment strategies.