{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T05:20:20Z","timestamp":1793337620586,"version":"4.5.0"},"reference-count":107,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T00:00:00Z","timestamp":1638662400000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Gemeinsamer Bundesausschuss","award":["01NVF17009"],"award-info":[{"award-number":["01NVF17009"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,26]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Patients undergoing surgery for severe aortic stenosis (SAS) can be treated with either transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). The choice of procedure depends on several factors, including the clinical judgement of the heart team and patient preferences, which are captured by actively informing and involving patients in a process of shared decision making (SDM). We synthesised the most up-to-date and accessible evidence on the benefits and risks that may be associated with TAVI versus SAVR to support SDM in this highly personalised decision-making process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>MEDLINE (Ovid), Embase (Ovid) and the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley) were searched from January 2000 to August 2020 with no language restrictions. Reference lists of included studies were searched to identify additional studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Randomised controlled trials (RCTs) that compared TAVI versus SAVR in patients with SAS and reported on all-cause or cardiovascular mortality, length of stay in intensive care unit or hospital, valve durability, rehospitalisation\/reintervention, stroke (any stroke or major\/disabling stroke), myocardial infarction, major vascular complications, major bleeding, permanent pacemaker (PPM) implantation, new-onset or worsening atrial fibrillation (NOW-AF), endocarditis, acute kidney injury (AKI), recovery time or pain were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>\n                      Two independent reviewers were involved in data extraction and risk of bias (ROB) assessment using the Cochrane tool (one reviewer extracted\/assessed the data, and the second reviewer checked it). Dichotomous data were pooled using the Mantel-Haenszel method with random-effects to generate a risk ratio (RR) with 95% CI. Continuous data were pooled using the inverse-variance method with random-effects and expressed as a mean difference (MD) with 95% CI. Heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>8969 records were retrieved and nine RCTs (61 records) were ultimately included (n=8818 participants). Two RCTs recruited high-risk patients, two RCTs recruited intermediate-risk patients, two RCTs recruited low-risk patients, one RCT recruited high-risk (\u226570 years) or any-risk (\u226580 years) patients; and two RCTs recruited all-risk or \u2018operable\u2019 patients. While there was no overall change in the risk of dying from any cause (30 day: RR 0.89, 95% CI 0.65 to 1.22; \u22641 year: RR 0.90, 95% CI 0.79 to 1.03; 5 years: RR 1.09, 95% CI 0.98 to 1.22), cardiovascular mortality (30 day: RR 1.03, 95% CI 0.77 to 1.39; \u22641 year: RR 0.90, 95% CI 0.76 to 1.06; 2 years: RR 0.96, 95% CI 0.83 to 1.12), or any type of stroke (30 day: RR 0.83, 95% CI 0.61 to 1.14;\u22641 year: RR 0.94, 95% CI 0.72 to 1.23; 5 years: RR 1.07, 95% CI 0.88 to 1.30), the risk of several clinical outcomes was significantly decreased (major bleeding, AKI, NOW-AF) or significantly increased (major vascular complications, PPM implantation) for TAVI vs SAVR. TAVI was associated with a significantly shorter hospital stay vs SAVR (MD \u22123.08 days, 95% CI \u22124.86 to \u22121.29; 4 RCTs, n=2758 participants). Subgroup analysis generally favoured TAVI patients receiving implantation via the transfemoral (TF) route (vs non-TF); receiving a balloon-expandable (vs self-expanding) valve; and those at low-intermediate risk (vs high risk). All RCTs were rated at high ROB, predominantly due to lack of blinding and selective reporting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>No overall change in the risk of death from any cause or cardiovascular mortality was identified but 95% CIs were often wide, indicating uncertainty. TAVI may reduce the risk of certain side effects while SAVR may reduce the risk of others. Most long-term (5-year) results are limited to older patients at high surgical risk (ie, early trials), therefore more data are required for low risk populations. Ultimately, neither surgical technique was considered dominant, and these results suggest that every patient with SAS should be individually engaged in SDM to make evidence-based, personalised decisions around their care based on the various benefits and risks associated with each treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42019138171.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-054222","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T15:14:24Z","timestamp":1666710864000},"page":"e054222","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":64,"title":["Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8545-8322","authenticated-orcid":false,"given":"Stephanie Louise","family":"Swift","sequence":"first","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-1892","authenticated-orcid":false,"given":"Thomas","family":"Puehler","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"},{"name":"German Centre for Cardiovascular Research, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Misso","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4883-8393","authenticated-orcid":false,"given":"Shona Helen","family":"Lang","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Forbes","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos","family":"Kleijnen","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0653-4092","authenticated-orcid":false,"given":"Marion","family":"Danner","sequence":"additional","affiliation":[{"name":"National Competency Center for Shared Decision Making, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kuhn","sequence":"additional","affiliation":[{"name":"German Centre for Cardiovascular Research, Kiel, Germany"},{"name":"Department of Cardiology and Angiology, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatim","family":"Seoudy","sequence":"additional","affiliation":[{"name":"German Centre for Cardiovascular Research, Kiel, Germany"},{"name":"Department of Cardiology and Angiology, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochen","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Frey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, and Pneumology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Lutter","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Vascular Surgery, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"},{"name":"German Centre for Cardiovascular Research, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3270-7791","authenticated-orcid":false,"given":"Robert","family":"Wolff","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fueloep","family":"Scheibler","sequence":"additional","affiliation":[{"name":"National Competency Center for Shared Decision Making, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Wehkamp","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derk","family":"Frank","sequence":"additional","affiliation":[{"name":"German Centre for Cardiovascular Research, Kiel, Germany"},{"name":"Department of Cardiology and Angiology, Universit\u00e4tsklinikum Schleswig-Holstein, Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,6]]},"reference":[{"key":"2025120518564736000_11.12.e054222.1","doi-asserted-by":"publisher","DOI":"10.15420\/icr.2021.02"},{"key":"2025120518564736000_11.12.e054222.2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.echo.2017.10.020","article-title":"ACC\/AATS\/AHA\/ASE\/EACTS\/HVS\/SCA\/SCAI\/SCCT\/SCMR\/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis: a report of the American College of cardiology appropriate use criteria Task force, American association for thoracic surgery, American heart association, American Society of echocardiography, European association for Cardio-Thoracic surgery, heart valve Society, society of cardiovascular Anesthesiologists, Society for cardiovascular angiography and interventions, society of cardiovascular computed tomography, Society for cardiovascular magnetic resonance, and society of thoracic surgeons","volume":"31","author":"Bonow","year":"2018","journal-title":"J Am Soc Echocardiogr"},{"key":"2025120518564736000_11.12.e054222.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"2025120518564736000_11.12.e054222.4","doi-asserted-by":"crossref","unstructured":"Kuck K-H , Eggebrecht H , Els\u00e4sser A . Qualit\u00e4tskriterien Zur Durchf\u00fchrung Der kathetergest\u00fctzten Aortenklappenimplantation (TAVI): Aktualisierung des Positionspapiers Der Deutschen Gesellschaft f\u00fcr Kardiologie. Berlin: Springer-Verlag, 2016.","DOI":"10.1007\/s12181-016-0082-4"},{"key":"2025120518564736000_11.12.e054222.5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2019-316055"},{"key":"2025120518564736000_11.12.e054222.6","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1001\/jamacardio.2019.5719","article-title":"The learning curve for shared decision-making in symptomatic aortic stenosis","volume":"5","author":"Coylewright","year":"2020","journal-title":"JAMA Cardiol"},{"key":"2025120518564736000_11.12.e054222.7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/ejcts\/ezaa087","article-title":"Mortality in trials on transcatheter aortic valve implantation versus surgical aortic valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data","volume":"58","author":"Barili","year":"2020","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025120518564736000_11.12.e054222.8","doi-asserted-by":"crossref","first-page":"346","DOI":"10.21470\/1678-9741-2019-0288","article-title":"Transcatheter aortic valve implantation versus surgical aortic valve replacement for treatment of severe aortic stenosis: comparison of results from randomized controlled trials and real-world data","volume":"35","author":"Wang","year":"2020","journal-title":"Braz J Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz275"},{"key":"2025120518564736000_11.12.e054222.10","unstructured":"Toff WD . United Kingdom Transcatheter Aortic Valve Implantation - UK TAVI. Presented at ACC 2020 (World Congress of Cardiology); 28-30 March 2020; Chicago, IL [online] Washington, DC: American College of Cardiology, 2020. Available: https:\/\/www.acc.org\/latest-in-cardiology\/clinical-trials\/2020\/03\/26\/21\/14\/uk-tavi [Accessed 14 Aug 2020]."},{"key":"2025120518564736000_11.12.e054222.11","unstructured":"University of Leicester . The United Kingdom Transcatheter Aortic Valve Implantation (UK TAVI) Trial. A multi-centre randomised controlled trial to assess the clinical effectiveness and cost utility of TAVI, compared with conventional surgical aortic valve replacement (AVR), in patients with severe symptomatic aortic stenosis at intermediate or high operative risk, 2013. Available: http:\/\/apps.who.int\/trialsearch\/Trial2.aspx?TrialID=ISRCTN57819173CN-01856898"},{"key":"2025120518564736000_11.12.e054222.12","unstructured":"Share to Care Gemeinsam entscheiden . Willkommen bei SHARE TO CARE: homepage [online], 2019. Available: https:\/\/abnahme-kiel.share-to-care.de\/ [Accessed 19 Jun 2019]."},{"key":"2025120518564736000_11.12.e054222.13","unstructured":"Higgins JPT , Green S , eds. Cochrane handbook for systematic reviews of interventions [online]. Version 5.1.0 [updated March 2011]: The Cochrane Collaboration, 2011."},{"key":"2025120518564736000_11.12.e054222.14","unstructured":"Centre for Reviews and Dissemination . Systematic reviews: CRD\u2019s guidance for undertaking reviews in health care [online]. York: University of York, 2009."},{"key":"2025120518564736000_11.12.e054222.15","unstructured":"PRISMA Group . PRISMA (Preferred reporting items for systematic reviews and meta-analyses) statement [online]. Available: http:\/\/prisma-statement.org\/ [Accessed 18 Jun 2015]."},{"key":"2025120518564736000_11.12.e054222.16","unstructured":"Swift S , Wolff R , Misso K . Comparative effectiveness and safety of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in elderly (>75 years) patients with severe aortic stenosis: a systematic review and meta-analysis. PROSPERO protocol: CRD42019138171 [online], 24th June 2019."},{"key":"2025120518564736000_11.12.e054222.17","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000047200.36165.B8"},{"key":"2025120518564736000_11.12.e054222.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"2025120518564736000_11.12.e054222.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38926.629329.AE"},{"key":"2025120518564736000_11.12.e054222.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002"},{"key":"2025120518564736000_11.12.e054222.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1514616"},{"key":"2025120518564736000_11.12.e054222.22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1814052"},{"key":"2025120518564736000_11.12.e054222.23","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1400590"},{"key":"2025120518564736000_11.12.e054222.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1816885"},{"key":"2025120518564736000_11.12.e054222.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.03.014"},{"key":"2025120518564736000_11.12.e054222.26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1103510"},{"key":"2025120518564736000_11.12.e054222.27","doi-asserted-by":"publisher","DOI":"10.4244\/EIJV8I3A58"},{"key":"2025120518564736000_11.12.e054222.28","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700456"},{"key":"2025120518564736000_11.12.e054222.29","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.amjcard.2019.05.017","article-title":"Meta-Analysis of effectiveness and safety of transcatheter aortic valve implantation versus surgical aortic valve replacement in low-to-intermediate surgical risk cohort","volume":"124","author":"Ando","year":"2019","journal-title":"Am J Cardiol"},{"key":"2025120518564736000_11.12.e054222.30","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.hlc.2020.05.112","article-title":"Transcatheter versus surgical aortic valve replacement: an updated systematic review and meta-analysis with a focus on outcomes by sex","volume":"30","author":"Dagan","year":"2021","journal-title":"Heart Lung Circ"},{"key":"2025120518564736000_11.12.e054222.31","doi-asserted-by":"crossref","first-page":"135","DOI":"10.21037\/cdt.2020.02.11","article-title":"Comparison of surgical versus transcatheter aortic valve replacement for patients with aortic stenosis at low-intermediate risk","volume":"10","author":"Khan","year":"2020","journal-title":"Cardiovasc Diagn Ther"},{"key":"2025120518564736000_11.12.e054222.32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ijcard.2020.04.022","article-title":"Assessing the safety and efficacy of TAVR compared to SAVR in low-to-intermediate surgical risk patients with aortic valve stenosis: an overview of reviews","volume":"314","author":"Mc Morrow","year":"2020","journal-title":"Int J Cardiol"},{"key":"2025120518564736000_11.12.e054222.33","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.amjcard.2019.10.057","article-title":"Meta-analysis comparing results of transcatheter versus surgical aortic-valve replacement in patients with severe aortic stenosis","volume":"125","author":"Zhang","year":"2020","journal-title":"Am J Cardiol"},{"key":"2025120518564736000_11.12.e054222.34","unstructured":"Makkar RR , Thourani VH , Mack MJ . Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med 2020;382."},{"key":"2025120518564736000_11.12.e054222.35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200384"},{"key":"2025120518564736000_11.12.e054222.36","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1016\/j.jtcvs.2018.02.092","article-title":"Comparison of transcatheter versus surgical aortic valve implantation in high-risk patients: a nationwide study in France","volume":"156","author":"Armoiry","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.37","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.119.007825","article-title":"Five-year outcomes of transfemoral transcatheter aortic valve replacement or surgical aortic valve replacement in a real world population","volume":"12","author":"Barbanti","year":"2019","journal-title":"Circ Cardiovasc Interv"},{"key":"2025120518564736000_11.12.e054222.38","first-page":"597","article-title":"Propensity score: an alternative method of analyzing treatment effects - part 23 of a series on evaluation of scientific publications]","volume":"113","author":"Kuss","year":"2016","journal-title":"Dtsch Arztebl Int"},{"key":"2025120518564736000_11.12.e054222.39","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1093\/ejcts\/ezz245","article-title":"Transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients: a propensity score-matched analysis","volume":"56","author":"Schaefer","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025120518564736000_11.12.e054222.40","unstructured":"Universit\u00e4tsklinikum Hamburg-Eppendorf, Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung (DZHK) . Randomized trial of TAVI vs. SAVR in patients with severe aortic valve stenosis at intermediate risk of mortality [online]. Bethesda, MD: National Library of Medicine, 2017. https:\/\/clinicaltrials.gov\/show\/nct03112980CN-01563392"},{"key":"2025120518564736000_11.12.e054222.41","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1093\/eurheartj\/ehy851","article-title":"The DEDICATE trial: an independent all-comers trial of transcatheter aortic valve implantation vs. surgical aortic valve replacement in patients at low to intermediate operative risk is recruiting patients","volume":"40","author":"Seiffert","year":"2019","journal-title":"Eur Heart J"},{"key":"2025120518564736000_11.12.e054222.42","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ahj.2020.06.016","article-title":"Rationale and design of a prospective, randomized, controlled, multicenter study to evaluate the safety and efficacy of transcatheter heart valve replacement in female patients with severe symptomatic aortic stenosis requiring aortic valve intervention (Randomized researcH in womEn all comers wIth Aortic stenosis [RHEIA] trial)","volume":"228","author":"Eltchaninoff","year":"2020","journal-title":"Am Heart J"},{"key":"2025120518564736000_11.12.e054222.43","unstructured":"Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Quebec . Transcatheter aortic valve replacement versu surgical aortix valve replacement for treating elderly patients with severe aortic stenosis and small aortic annuli: a prospective randomized study the VIVA Trial. NCT03383445. In: ClinicalTrials.gov [online]. Bethesda, MD: National Library of Medicine (US), 2017. https:\/\/clinicaltrials.gov\/show\/nct03383445"},{"key":"2025120518564736000_11.12.e054222.44","doi-asserted-by":"crossref","DOI":"10.1186\/s13019-020-01170-7","article-title":"Structural durability of early-generation transcatheter aortic valve replacement valves compared with surgical aortic valve replacement valves in heart valve surgery: a systematic review and meta-analysis","volume":"15","author":"Ler","year":"2020","journal-title":"J Cardiothorac Surg"},{"key":"2025120518564736000_11.12.e054222.45","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1007\/s12471-020-01378-1","article-title":"Mortality after transcatheter versus surgical aortic valve replacement: an updated meta-analysis of randomised trials","volume":"28","author":"Takagi","year":"2020","journal-title":"Neth Heart J"},{"key":"2025120518564736000_11.12.e054222.46","first-page":"107","article-title":"A meta-analysis of \u22655-year mortality after transcatheter versus surgical aortic valve replacement","volume":"61","author":"Takagi","year":"2020","journal-title":"J Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.47","first-page":"27","article-title":"Network meta-analysis of surgical aortic valve replacement and different transcatheter heart valve systems for symptomatic severe aortic stenosis","volume":"37","author":"Ueyama","year":"2021","journal-title":"Can J Cardiol"},{"key":"2025120518564736000_11.12.e054222.48","article-title":"Response to the comment on \"long-term and temporal outcomes of transcatheter versus surgical aortic-valve replacement in severe aortic atenosis: a meta-analysis\"","author":"Zhang","year":"2020","journal-title":"Ann Surg"},{"key":"2025120518564736000_11.12.e054222.49","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1016\/j.amjmed.2019.06.020","article-title":"Meta-analysis of transcatheter aortic valve replacement in low-risk patients","volume":"133","author":"Kheiri","year":"2020","journal-title":"Am J Med"},{"key":"2025120518564736000_11.12.e054222.50","article-title":"Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk","volume":"12","author":"Kolkailah","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120518564736000_11.12.e054222.51","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.carrev.2019.08.009","article-title":"Cardiovascular outcomes with transcatheter vs. surgical aortic valve replacement in low-risk patients: an updated meta-analysis of randomized controlled trials","volume":"21","author":"Kundu","year":"2020","journal-title":"Cardiovasc Revasc Med"},{"key":"2025120518564736000_11.12.e054222.52","first-page":"43","article-title":"A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis","volume":"17","author":"Malik","year":"2020","journal-title":"J Geriatr Cardiol"},{"key":"2025120518564736000_11.12.e054222.53","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9020439","article-title":"Transcatheter versus surgical aortic valve replacement in low-risk patients for the treatment of severe aortic stenosis","volume":"9","author":"Polimeni","year":"2020","journal-title":"J Clin Med"},{"key":"2025120518564736000_11.12.e054222.54","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.amjcard.2019.10.036","article-title":"Meta-Analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with low surgical risk","volume":"125","author":"Vipparthy","year":"2020","journal-title":"Am J Cardiol"},{"key":"2025120518564736000_11.12.e054222.55","doi-asserted-by":"publisher","DOI":"10.7326\/M16-0060"},{"key":"2025120518564736000_11.12.e054222.56","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0196877","article-title":"Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: a systematic review and meta-analysis","volume":"13","author":"Liu","year":"2018","journal-title":"PLoS One"},{"key":"2025120518564736000_11.12.e054222.57","doi-asserted-by":"crossref","first-page":"1769","DOI":"10.1056\/NEJMe1903316","article-title":"Informed shared decisions for patients with aortic stenosis","volume":"380","author":"Otto","year":"2019","journal-title":"N Engl J Med"},{"key":"2025120518564736000_11.12.e054222.58","doi-asserted-by":"crossref","first-page":"e1027","DOI":"10.4244\/EIJV15I12A191","article-title":"The role of the heart team in the planning of aortic valve replacement","volume":"15","author":"Costa","year":"2019","journal-title":"EuroIntervention"},{"key":"2025120518564736000_11.12.e054222.59","article-title":"Long-term valve performance of TAVR and SAVR: a report from the partner I trial","author":"Daubert","year":"2016","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025120518564736000_11.12.e054222.60","unstructured":"Edwards Lifesciences . The partner trial: placement of aortic transcatheter valve trial. Bethesda, MD: National Library of Medicine, 2010. https:\/\/ClinicalTrials.gov\/show\/NCT00530894"},{"key":"2025120518564736000_11.12.e054222.61","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001335"},{"key":"2025120518564736000_11.12.e054222.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.058"},{"key":"2025120518564736000_11.12.e054222.63","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(12)60003-5"},{"key":"2025120518564736000_11.12.e054222.64","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60308-7"},{"key":"2025120518564736000_11.12.e054222.65","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.01.055"},{"key":"2025120518564736000_11.12.e054222.66","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.03.075"},{"key":"2025120518564736000_11.12.e054222.67","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.08.1666"},{"key":"2025120518564736000_11.12.e054222.68","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.04.018"},{"key":"2025120518564736000_11.12.e054222.69","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.163"},{"key":"2025120518564736000_11.12.e054222.70","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1053\/j.semtcvs.2017.06.001","article-title":"Complications after self-expanding transcatheter or surgical aortic valve replacement","volume":"29","author":"Conte","year":"2017","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.71","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.03.506"},{"key":"2025120518564736000_11.12.e054222.72","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1016\/j.jtcvs.2016.11.069","article-title":"Causes of death from the randomized CoreValve US pivotal high-risk trial","volume":"153","author":"Gaudiani","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.73","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.08.2146"},{"key":"2025120518564736000_11.12.e054222.74","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jtcvs.2016.02.073","article-title":"The risk and extent of neurologic events are equivalent for high-risk patients treated with transcatheter or surgical aortic valve replacement","volume":"152","author":"Gleason","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.75","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.115.003426","article-title":"Self-expanding transcatheter aortic valve replacement versus surgical valve replacement in patients at high risk for surgery: a study of echocardiographic change and risk prediction","volume":"9","author":"Little","year":"2016","journal-title":"Circ Cardiovasc Interv"},{"key":"2025120518564736000_11.12.e054222.76","unstructured":"Medtronic Cardiovascular . Safety and efficacy study of the Medtronic CoreValve\u00ae system in the treatment of symptomatic severe aortic stenosis in high risk and very high risk subjects who need aortic valve replacement. NCT01240902. In: ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US) 2014 [accessed 4.6.19] [ Order SS]. Available from:. Available: https:\/\/ClinicalTrials.gov\/show\/NCT01240902"},{"key":"2025120518564736000_11.12.e054222.77","doi-asserted-by":"crossref","DOI":"10.1016\/S0735-1097(16)30122-X","article-title":"Outcomes in the CoreValve us high-risk pivotal trial in patients with a Society of thoracic surgeons predicted risk of mortality less than or equal to 7","volume":"67","author":"Reardon","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2025120518564736000_11.12.e054222.78","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.05.017"},{"key":"2025120518564736000_11.12.e054222.79","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1001\/jamacardio.2016.2257","article-title":"Outcomes in the randomized CoreValve US pivotal high risk trial in patients with a Society of Thoracic Surgeons risk score of 7% or less","volume":"1","author":"Reardon","year":"2016","journal-title":"JAMA Cardiol"},{"key":"2025120518564736000_11.12.e054222.80","first-page":"947","article-title":"Pathology of self-expanding transcatheter aortic valves: findings from the CoreValve us pivotal trials","volume":"91","author":"Yahagi","year":"2018","journal-title":"Catheter Cardiovasc Interv"},{"key":"2025120518564736000_11.12.e054222.81","doi-asserted-by":"crossref","DOI":"10.1016\/S0735-1097(20)31736-8","article-title":"5-year health status outcomes after self-expanding transcatheter or surgical aortic valve replacement in high-risk patients with severe aortic stenosis. Presented at the ACC 20 - World Congress of Cardiology","volume":"75","author":"Arnold","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025120518564736000_11.12.e054222.82","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1001\/jamacardio.2017.2039","article-title":"Health status benefits of transcatheter vs surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial","volume":"2","author":"Baron","year":"2017","journal-title":"JAMA Cardiol"},{"key":"2025120518564736000_11.12.e054222.83","unstructured":"Edwards Lifesciences . The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII A [online]. Bethesda, MD: National Library of Medicine, 2016. https:\/\/ClinicalTrials.gov\/show\/NCT01314313"},{"key":"2025120518564736000_11.12.e054222.84","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.jtcvs.2018.11.129","article-title":"Causes of death in intermediate-risk patients: the randomized surgical replacement and transcatheter aortic valve implantation trial","volume":"158","author":"Amrane","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120518564736000_11.12.e054222.85","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.07.093"},{"key":"2025120518564736000_11.12.e054222.86","doi-asserted-by":"crossref","unstructured":"Kiaii B , Reardon M , Popma J . Clinical impact of atrial fibrillation following surgical or transcatheter aortic valve replacement in patients at intermediate surgical risk: results from the SURTAVI trial. J Am Coll Cardiol 2018.","DOI":"10.1016\/S0735-1097(18)31872-2"},{"key":"2025120518564736000_11.12.e054222.87","unstructured":"Medtronic Cardiovascular . Safety and efficacy study of the medtronic CoreValve\u00ae system in the treatment of severe, symptomatic aortic stenosis in intermediate risk subjects who need aortic valve replacement (SURTAVI. Bethesda, MD: National Library of Medicine, 2018. https:\/\/ClinicalTrials.gov\/show\/NCT01586910"},{"key":"2025120518564736000_11.12.e054222.88","doi-asserted-by":"crossref","unstructured":"Popma JJ , Van Mieghem N , Reardon MJ . Functional status after transcatheter and surgical aortic valve replacement: a two-year analysis from the SURTAVI trial. J Am Coll Cardiol 2017.","DOI":"10.1016\/j.jacc.2017.09.436"},{"key":"2025120518564736000_11.12.e054222.89","doi-asserted-by":"crossref","unstructured":"Serruys P , Abdelghani M , Popma JJ . Clinical outcomes of surgical or transcatheter aortic-valve replacement in intermediate-risk patients stratified by STS score: results from the SURTAVI trial. J Am Coll Cardiol 2017.","DOI":"10.1016\/j.jacc.2017.09.435"},{"key":"2025120518564736000_11.12.e054222.90","doi-asserted-by":"crossref","first-page":"877","DOI":"10.4244\/EIJ-D-18-00460","article-title":"One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial","volume":"14","author":"Serruys","year":"2018","journal-title":"EuroIntervention"},{"key":"2025120518564736000_11.12.e054222.91","doi-asserted-by":"crossref","unstructured":"Van Mieghem N , Reardon MJ , Popma JJ . Transcatheter aortic valve replacement with a self-expanding prosthesis or surgical aortic valve replacement in intermediate-risk patients: complete 1-year outcomes from the surtavi trial. J Am Coll Cardiol 2017.","DOI":"10.1016\/j.jacc.2017.09.163"},{"key":"2025120518564736000_11.12.e054222.92","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.10.043"},{"key":"2025120518564736000_11.12.e054222.93","unstructured":"Medtronic Cardiovascular . Medtronic evolut transcatheter aortic valve replacement in low risk patients [online]. Bethesda, MD: National Library of Medicine, 2016. https:\/\/clinicaltrials.gov\/show\/nct02701283CN-01576135"},{"key":"2025120518564736000_11.12.e054222.94","unstructured":"National Library of Medicine . Edwards Lifesciences The PARTNER 3 trial: the safety and effectiveness of the SAPIEN 3 transcatheter heart valve in low risk patients with aortic stenosis [online]. Bethesda, MD: National Library of Medicine, 2016. https:\/\/clinicaltrials.gov\/show\/nct02675114CN-01555589"},{"key":"2025120518564736000_11.12.e054222.95","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.09.007"},{"key":"2025120518564736000_11.12.e054222.96","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.044574"},{"key":"2025120518564736000_11.12.e054222.97","unstructured":"Mack MJ , Leon MB . Two year clinical and echocardiographic outcomes from the PARTNER 3 low risk randomized trial. Presented at ACC 2020 (World Congress of Cardiology); 28-30 March 2020; Chicago, IL [online]. Washington, DC: American College of Cardiology, 2020. https:\/\/www.acc.org\/latest-in-cardiology\/clinical-trials\/2019\/03\/15\/18\/29\/partner-3"},{"key":"2025120518564736000_11.12.e054222.98","unstructured":"Jorgensen TH , Thygesen JB , Thyregod HG . Temporal changes in new-onset atrial fibrillation after TAVI or SAVR for aortic stenosis: a randomised study. EuroIntervention 2013;9."},{"key":"2025120518564736000_11.12.e054222.99","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ijcard.2017.02.098","article-title":"Temporal changes of new-onset atrial fibrillation in patients randomized to surgical or transcatheter aortic valve replacement","volume":"234","author":"J\u00f8rgensen","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025120518564736000_11.12.e054222.100","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/ehjci\/jew321","article-title":"Differences in left ventricular remodelling in patients with aortic stenosis treated with transcatheter aortic valve replacement with CoreValve prostheses compared to surgery with porcine or bovine biological prostheses","volume":"19","author":"Ngo","year":"2018","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025120518564736000_11.12.e054222.101","unstructured":"Rigshospitalet Denmark, Odense University Hospital, Sahlgrenska University Hospital Sweden . The nordic aortic valve intervention trial [online]. Bethesda, MD: National Library of Medicine, 2014. https:\/\/ClinicalTrials.gov\/show\/NCT01057173"},{"key":"2025120518564736000_11.12.e054222.102","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.083"},{"key":"2025120518564736000_11.12.e054222.103","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCINTERVENTIONS.115.003665","article-title":"Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers nordic aortic valve intervention randomized clinical trial","volume":"9","author":"S\u00f8ndergaard","year":"2016","journal-title":"Circ Cardiovasc Interv"},{"key":"2025120518564736000_11.12.e054222.104","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-14-11"},{"key":"2025120518564736000_11.12.e054222.105","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCULATIONAHA.118.036606","article-title":"Five-year clinical and echocardiographic outcomes from the Nordic aortic valve intervention (NOTION) randomized clinical trial in lower surgical risk patients","author":"Thyregod","year":"2019","journal-title":"Circulation"},{"key":"2025120518564736000_11.12.e054222.106","unstructured":"Aarhus University Hospital Skejby, Odense University Hospital, Danish Heart Foundation . Transapical transcatheter treatment versus conventional surgery in patients with native aortic valve stenosis [online]. Bethesda, MD: National Library of Medicine, 2011. https:\/\/ClinicalTrials.gov\/show\/NCT00986193"},{"key":"2025120518564736000_11.12.e054222.107","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1080\/14017431.2016.1235725","article-title":"Health-related quality-of-life after transapical transcatheter aortic valve implantation","volume":"50","author":"Rex","year":"2016","journal-title":"Scand Cardiovasc J"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-054222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T02:57:05Z","timestamp":1764989825000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-054222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":107,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,6]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bmjopen-2021-054222"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-054222","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}