Valvular & structural heart disease
Comparative Effectiveness of Transcatheter Aortic Valve Implantation (TAVI) Platforms and Surgical Aortic Valve Replacement: A Network Meta-Analysis of Randomized Controlled Trials
Authors' conclusion
TAVI with CoreValve-Evolut is probably associated with similar mortality to SAVR. TAVI with SAPIEN and ACURATE neo were associated with increased risk of mortality compared with SAVR and CoreValve-Evolut. The current body of evidence from randomized controlled trials goes against the hypothesis of a class effect across TAVI valves.
Study context
- Population
- RCTs comparing commercially available TAVI devices with other TAVI devices or surgical aortic valve replacement (SAVR)
- Participants
- 9,946 participants11 RCTs
- Comparison
- TAVI platforms vs each other and vs SAVR
- Outcome
- All-cause mortality, CV mortality and stroke (critically important patient-centred outcomes)
- Follow-up
- Outcomes reported between 1 to 10 years
Methodological detailsfrequentist network meta-analysis, GRADE certainty assessment
- Frequentist network meta-analysis
- GRADE certainty assessment
Pooled result
As reported in the abstract
Each group vs SAVRARD (CI)
ACURATE neoCV mortality; moderate certainty
105(7–247)
- CoreValve-Evolut · all-cause mortality; moderate certainty
- ARD 31/1000 (CI −12 to 79)
- CoreValve-Evolut · CV mortality; moderate certainty
- ARD −8/1000 (CI −39 to 28)
- SAPIEN · all-cause mortality; high certainty
- ARD 109/1000 (CI 56–169)
- ACURATE neo · all-cause mortality; moderate certainty
- ARD 123/1000 (CI 9–277)
- SAPIEN · CV mortality; high certainty
- ARD 58/1000 (CI 18–105)
Further pooled results
| Outcome | ARD (CI) |
|---|---|
| Mortality vs CoreValve-EvolutSAPIEN vs CoreValve-Evolut · all-cause mortality; high certainty | 75/1000 (13–147) |
| Mortality vs CoreValve-EvolutSAPIEN vs CoreValve-Evolut · CV mortality; high certainty | 66/1000 (15–130) |
| Mortality vs CoreValve-EvolutACURATE neo vs CoreValve-Evolut · high certainty | 113/1000 (13–259) |
Safety
- All TAVI platforms associated with increased risk of reinterventions and pacemaker implant vs SAVR (moderate and high certainty)
Original publication
Comparative Effectiveness of TAVI Platforms and Surgical Aortic Valve Replacement: A Network Meta-Analysis of Randomized Controlled Trials. Circ Cardiovasc Interv. Published 11 September 2025. doi:10.
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