Early Valve Replacement vs Surveillance in Moderate Aortic Stenosis: Meta-Analysis of Randomized and Observational Evidence

Early transcatheter aortic valve replacement versus clinical surveillance in older, predominantly symptomatic moderate aortic stenosis shows no detectable 2-year mortality change (HR 1.05; 95% CI 0.74–1.49).

• Why it matters: Moderate aortic stenosis carries excess mortality, but it is unclear whether early TAVR improves outcomes compared with surveillance, and observational results may mislead decisions.
• What they did: The authors meta-analyzed 2 randomized trials (922 patients: TAVR UNLOAD, n=178; PROGRESS, n=744) and 7 adjusted observational cohorts, rating certainty with GRADE.
• The result: Early TAVR reduced heart failure hospitalization (RR 0.53; 95% CI 0.36–0.77; ~70 fewer per 1,000 at 2 years) but increased new pacemakers in PROGRESS (17.3% vs 9.3%); observational cohorts estimated greater mortality benefit (HR 0.52) that differed from trials (ratio of HRs 2.01).

AI summary of the abstract · may contain errors · not medical advice · read the paper.