Long-Term Results Following Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients With Severe Aortic Stenosis: A Systematic Review and Meta-Analysis of Randomized Trials

•Transcatheter aortic valve replacement (TAVR) is already a well-established treatment for severe aortic valve stenosis in patients aged >75 years across all surgical risk categories; however, there are limited long-term data in younger low-risk patients.•Our meta-analysis shows a similar durability and a comparable risk of all-cause death, cardiovascular death, myocardial infarction, disabling stroke, aortic valve reintervention, and endocarditis between TAVR and surgical aortic valve replacement.•Based on these results, the indication for TAVR could be extended to selected younger patients at low surgical risk. Transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for patients with severe aortic stenosis at intermediate or high surgical risk. Results after TAVR in low-risk patients are very encouraging at midterm follow-up, whereas limited long-term (≥3 year) data are available in this subset of patients. This meta-analysis aims to compare the long-term follow-up after TAVR versus surgical aortic valve replacement (SAVR) in low-risk patients. We searched databases up to July 7, 2024 for randomized clinical trials comparing TAVR versus SAVR in low-risk patients (defined as Society of Thoracic Surgeons Predicted Risk of Mortality score