TRANSCATHETER VS SURGICAL AORTIC VALVE REPLACEMENT: A COMPREHENSIVE REVIEW OF INDICATIONS AND OUTCOMES
Main Article Content
Keywords
aortic stenosis, transcatheter aortic valve replacement, surgical aortic valve replacement, clinical outcomes, valve durability
Abstract
Aortic stenosis is a progressive valvular disorder associated with significant morbidity and mortality if left untreated. Surgical aortic valve replacement (SAVR) has long been the standard therapy; however, the emergence and rapid evolution of transcatheter aortic valve replacement (TAVR) have transformed the management of this condition across a broad spectrum of patient risk profiles. This comprehensive review synthesizes current evidence comparing TAVR and SAVR with respect to clinical indications, procedural approaches, and patient outcomes. Major biomedical databases were reviewed to identify randomized trials, observational studies, registry data, and international guideline recommendations relevant to aortic valve replacement. Outcomes assessed include mortality, major adverse cardiovascular and cerebrovascular events, procedural and valve-related complications, durability, quality of life, and health system implications. Available evidence demonstrates that both TAVR and SAVR offer substantial survival and symptomatic benefit when appropriately applied, with TAVR providing advantages in early recovery and functional improvement, and SAVR maintaining an important role in younger patients and those requiring durable long-term solutions. Persistent uncertainties regarding valve durability, lifetime management strategies, and optimal patient selection particularly in low-risk populations remain key challenges. An individualized, multidisciplinary heart team approach integrating patient characteristics, anatomical considerations, and long-term goals is essential to optimizing outcomes as aortic valve replacement strategies continue to evolve.
References
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20. May, A. G., Deweese, J. A., & Rob, C. G. (1963). Hemodynamic effects of arterial stenosis. Surgery, 53(4), 513-524.
21. Morton, G., Masters, J., & Cowburn, P. J. (2018). Multidisciplinary team approach to heart failure management. Heart, 104(16), 1376-1382.
22. Nuis, R. J., Goudzwaard, J. A., de Ronde-Tillmans, M. J., Kroon, H., Ooms, J. F., van Wiechen, M. P., ... & de Jaegere, P. P. (2020). Impact of valvulo-arterial impedance on long-term quality of life and exercise performance after transcatheter aortic valve replacement. Circulation: Cardiovascular Interventions, 13(1), e008372.
23. Nyam, T. T. E., Ho, C. H., Chio, C. C., Lim, S. W., Wang, J. J., Chang, C. H., ... & Wang, C. C. (2019). Traumatic brain injury increases the risk of major adverse cardiovascular and cerebrovascular events: a 13-year, population-based study. World neurosurgery, 122, e740-e753.
24. Osnabrugge, R. L., Head, S. J., Genders, T. S., Van Mieghem, N. M., De Jaegere, P. P., van der Boon, R. M., ... & Hunink, M. M. (2012). Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients. The Annals of thoracic surgery, 94(6), 1954-1960.
25. Rodriguez-Gabella, T., Voisine, P., Puri, R., Pibarot, P., & Rodés-Cabau, J. (2017). Aortic bioprosthetic valve durability: incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. Journal of the American College of Cardiology, 70(8), 1013-1028.
26. Sá, M. P. B., Van den Eynde, J., Simonato, M., Cavalcanti, L. R. P., Doulamis, I. P., Weixler, V., ... & Clavel, M. A. (2021). Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: an updated meta-analysis. Cardiovascular Interventions, 14(2), 211-220.
27. Schymik, G., Heimeshoff, M., Bramlage, P., Herbinger, T., Würth, A., Pilz, L., ... & Schröfel, H. (2015). A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk. Catheterization and Cardiovascular interventions, 86(4), 738-744.
28. Shah, S. M., Shah, J., Lakey, S. M., Garg, P., & Ripley, D. P. (2023). Pathophysiology, emerging techniques for the assessment and novel treatment of aortic stenosis. Open Heart, 10(1).
29. Sintek, M., & Zajarias, A. (2014). Patient evaluation and selection for transcatheter aortic valve replacement: the heart team approach. Progress in cardiovascular diseases, 56(6), 572-582.
30. Siontis, G. C., Praz, F., Pilgrim, T., Mavridis, D., Verma, S., Salanti, G., ... & Windecker, S. (2016). Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. European heart journal, 37(47), 3503-3512.
31. Smilowitz, N. R., Gupta, N., Ramakrishna, H., Guo, Y., Berger, J. S., & Bangalore, S. (2017). Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA cardiology, 2(2), 181-187.
32. Straiton, N., Jin, K., Bhindi, R., & Gallagher, R. (2018). Functional capacity and health-related quality of life outcomes post transcatheter aortic valve replacement: a systematic review and meta-analysis. Age and Ageing, 47(3), 478-482.
33. Thaden, J. J., Nkomo, V. T., & Enriquez-Sarano, M. (2014). The global burden of aortic stenosis. Progress in cardiovascular diseases, 56(6), 565-571.
34. Virtanen, M. P., Eskola, M., Jalava, M. P., Husso, A., Laakso, T., Niemelä, M., ... & Biancari, F. (2019). Comparison of outcomes after transcatheter aortic valve replacement vs surgical aortic valve replacement among patients with aortic stenosis at low operative risk. JAMA network open, 2(6), e195742-e195742.
35. Young, M. N., Singh, V., & Sakhuja, R. (2018). A review of alternative access for transcatheter aortic valve replacement. Current Treatment Options in Cardiovascular Medicine, 20(7), 62.
2. Akahori, H., Tsujino, T., Masuyama, T., & Ishihara, M. (2018). Mechanisms of aortic stenosis. Journal of cardiology, 71(3), 215-220.
3. Arnold, S. V., Spertus, J. A., Vemulapalli, S., Li, Z., Matsouaka, R. A., Baron, S. J., ... & Cohen, D. J. (2017). Quality-of-life outcomes after transcatheter aortic valve replacement in an unselected population: a report from the STS/ACC Transcatheter Valve Therapy Registry. JAMA cardiology, 2(4), 409-416.
4. Arora, S., Misenheimer, J. A., Jones, W., Bahekar, A., Caughey, M., Ramm, C. J., ... & Vavalle, J. P. (2016). Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis. Cardiovascular diagnosis and therapy, 6(3), 241.
5. Arora, S., Strassle, P. D., Ramm, C. J., Rhodes, J. A., Vaidya, S. R., Caranasos, T. G., & Vavalle, J. P. (2017). Transcatheter versus surgical aortic valve replacement in patients with lower surgical risk scores: a systematic review and meta-analysis of early outcomes. Heart, Lung and Circulation, 26(8), 840-845.
6. Avvedimento, M., & Tang, G. H. (2021). Transcatheter aortic valve replacement (TAVR): Recent updates. Progress in cardiovascular diseases, 69, 73-83.
7. Bakris, G., Ali, W., & Parati, G. (2019). ACC/AHA versus ESC/ESH on hypertension guidelines: JACC guideline comparison. Journal of the American College of Cardiology, 73(23), 3018-3026.
8. Coccia, M. (2021). Evolution of technology in replacement of heart valves: Transcatheter aortic valves, a revolution for management of valvular heart diseases. Health Policy and Technology, 10(2), 100512.
9. De Rui, M., Tarzia, V., Mazzochin, M., Bertocco, A., Ceolin, C., Trevisan, C., ... & Sergi, G. (2022). Surgical aortic valve replacement in elderly patients: effects on physical performance, cognitive function and health-related quality of life. Aging clinical and experimental research, 34(3), 643-652.
10. Du, Y., Gössl, M., Garcia, S., Enriquez-Sarano, M., Cavalcante, J. L., Bae, R., ... & Sorajja, P. (2021). Natural history observations in moderate aortic stenosis. BMC Cardiovascular Disorders, 21(1), 108.
11. Duffy, M., Lynch, A., Reddin, C., Judge, C., O’Donnell, M., & Murphy, R. (2023). Comparing functional and quality of life outcomes in transcatheter aortic valve implantation and surgical aortic valve replacement for aortic stenosis: a systematic review and meta-analysis. BMC Cardiovascular Disorders, 23(1), 519.
12. Gao, F., Shan, L., Wang, C., Meng, X., Chen, J., Han, L., ... & Li, Z. (2021). Predictive ability of European heart surgery risk assessment system II (EuroSCORE II) and the society of thoracic surgeons (STS) score for in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting. International journal of general medicine, 8509-8519.
13. Genereux, P., Pibarot, P., Redfors, B., Bax, J. J., Zhao, Y., Makkar, R. R., ... & Cohen, D. J. (2022). Evolution and prognostic impact of cardiac damage after aortic valve replacement. Journal of the American College of Cardiology, 80(8), 783-800.
14. Généreux, P., Sharma, R. P., Cubeddu, R. J., Aaron, L., Abdelfattah, O. M., Koulogiannis, K. P., ... & Gillam, L. D. (2023). The mortality burden of untreated aortic stenosis. Journal of the American College of Cardiology, 82(22), 2101-2109.
15. Joseph, J., Naqvi, S. Y., Giri, J., & Goldberg, S. (2017). Aortic stenosis: pathophysiology, diagnosis, and therapy. The American journal of medicine, 130(3), 253-263.
16. Latib, A., Maisano, F., Bertoldi, L., Giacomini, A., Shannon, J., Cioni, M., ... & Colombo, A. (2012). Transcatheter vs surgical aortic valve replacement in intermediate-surgical-risk patients with aortic stenosis: a propensity score–matched case-control study. American heart journal, 164(6), 910-917.
17. Lee, G., Chikwe, J., Milojevic, M., Wijeysundera, H. C., Biondi-Zoccai, G., Flather, M., ... & Tam, D. Y. (2023). ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. European heart journal, 44(10), 796-812.
18. Lutz, K., Asturias, K. M., Garg, J., Poudyal, A., Lantz, G., Golwala, H., ... & Zahr, F. (2024). Alternative access for TAVR: choosing the right pathway. Journal of clinical medicine, 13(12), 3386.
19. Marro, M., Kossar, A. P., Xue, Y., Frasca, A., Levy, R. J., & Ferrari, G. (2021). Noncalcific mechanisms of bioprosthetic structural valve degeneration. Journal of the American Heart Association, 10(3), e018921.
20. May, A. G., Deweese, J. A., & Rob, C. G. (1963). Hemodynamic effects of arterial stenosis. Surgery, 53(4), 513-524.
21. Morton, G., Masters, J., & Cowburn, P. J. (2018). Multidisciplinary team approach to heart failure management. Heart, 104(16), 1376-1382.
22. Nuis, R. J., Goudzwaard, J. A., de Ronde-Tillmans, M. J., Kroon, H., Ooms, J. F., van Wiechen, M. P., ... & de Jaegere, P. P. (2020). Impact of valvulo-arterial impedance on long-term quality of life and exercise performance after transcatheter aortic valve replacement. Circulation: Cardiovascular Interventions, 13(1), e008372.
23. Nyam, T. T. E., Ho, C. H., Chio, C. C., Lim, S. W., Wang, J. J., Chang, C. H., ... & Wang, C. C. (2019). Traumatic brain injury increases the risk of major adverse cardiovascular and cerebrovascular events: a 13-year, population-based study. World neurosurgery, 122, e740-e753.
24. Osnabrugge, R. L., Head, S. J., Genders, T. S., Van Mieghem, N. M., De Jaegere, P. P., van der Boon, R. M., ... & Hunink, M. M. (2012). Costs of transcatheter versus surgical aortic valve replacement in intermediate-risk patients. The Annals of thoracic surgery, 94(6), 1954-1960.
25. Rodriguez-Gabella, T., Voisine, P., Puri, R., Pibarot, P., & Rodés-Cabau, J. (2017). Aortic bioprosthetic valve durability: incidence, mechanisms, predictors, and management of surgical and transcatheter valve degeneration. Journal of the American College of Cardiology, 70(8), 1013-1028.
26. Sá, M. P. B., Van den Eynde, J., Simonato, M., Cavalcanti, L. R. P., Doulamis, I. P., Weixler, V., ... & Clavel, M. A. (2021). Valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement: an updated meta-analysis. Cardiovascular Interventions, 14(2), 211-220.
27. Schymik, G., Heimeshoff, M., Bramlage, P., Herbinger, T., Würth, A., Pilz, L., ... & Schröfel, H. (2015). A comparison of transcatheter aortic valve implantation and surgical aortic valve replacement in 1,141 patients with severe symptomatic aortic stenosis and less than high risk. Catheterization and Cardiovascular interventions, 86(4), 738-744.
28. Shah, S. M., Shah, J., Lakey, S. M., Garg, P., & Ripley, D. P. (2023). Pathophysiology, emerging techniques for the assessment and novel treatment of aortic stenosis. Open Heart, 10(1).
29. Sintek, M., & Zajarias, A. (2014). Patient evaluation and selection for transcatheter aortic valve replacement: the heart team approach. Progress in cardiovascular diseases, 56(6), 572-582.
30. Siontis, G. C., Praz, F., Pilgrim, T., Mavridis, D., Verma, S., Salanti, G., ... & Windecker, S. (2016). Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. European heart journal, 37(47), 3503-3512.
31. Smilowitz, N. R., Gupta, N., Ramakrishna, H., Guo, Y., Berger, J. S., & Bangalore, S. (2017). Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery. JAMA cardiology, 2(2), 181-187.
32. Straiton, N., Jin, K., Bhindi, R., & Gallagher, R. (2018). Functional capacity and health-related quality of life outcomes post transcatheter aortic valve replacement: a systematic review and meta-analysis. Age and Ageing, 47(3), 478-482.
33. Thaden, J. J., Nkomo, V. T., & Enriquez-Sarano, M. (2014). The global burden of aortic stenosis. Progress in cardiovascular diseases, 56(6), 565-571.
34. Virtanen, M. P., Eskola, M., Jalava, M. P., Husso, A., Laakso, T., Niemelä, M., ... & Biancari, F. (2019). Comparison of outcomes after transcatheter aortic valve replacement vs surgical aortic valve replacement among patients with aortic stenosis at low operative risk. JAMA network open, 2(6), e195742-e195742.
35. Young, M. N., Singh, V., & Sakhuja, R. (2018). A review of alternative access for transcatheter aortic valve replacement. Current Treatment Options in Cardiovascular Medicine, 20(7), 62.
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Jan 30, 2026
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How to Cite
Dr .C.Devadoss. (2026). TRANSCATHETER VS SURGICAL AORTIC VALVE REPLACEMENT: A COMPREHENSIVE REVIEW OF INDICATIONS AND OUTCOMES. Journal of Population Therapeutics and Clinical Pharmacology, 33(1), 951-960. https://doi.org/10.53555/8ad6vw27
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Author Biography
Dr .C.Devadoss
Assistant professor, Arunai Medical College, Thiruvannamalai, Tamil Nadu Mgr Medical University, [email protected]
How to Cite
Dr .C.Devadoss. (2026). TRANSCATHETER VS SURGICAL AORTIC VALVE REPLACEMENT: A COMPREHENSIVE REVIEW OF INDICATIONS AND OUTCOMES. Journal of Population Therapeutics and Clinical Pharmacology, 33(1), 951-960. https://doi.org/10.53555/8ad6vw27
