{"id":"f8e6d9d54c0c","type":"article","url":"https://hartvaat.nl/2026/09/01/tavr-met-ballon-expanderbare-klep-heeft-vergelijkbare-overleving-en-minder-compl/","title":"TAVR met ballon-expanderbare klep heeft vergelijkbare overleving en minder complicaties dan chirurgische vervanging bij laag-risico aortastenose","title_en":"Transcatheter versus surgical aortic valve replacement for severe aortic stenosis in low-risk adults: a network meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Indian journal of thoracic and cardiovascular surgery","doi":"10.1007/s12055-026-02245-1","source_url":"https://doi.org/10.1007/s12055-026-02245-1","authors":["Kanandya Kizzandy","Yehezkiel Gian Pradipta Pahu","Satria Rafi Ratmandhika","Krisanto Tanjaya","Elsafira Rana Rinanada","Muhammad Yusuf","Muhammad Reva Aditya","Imam Suseno Bayuadi"],"significance":6,"published":"2026-08-13","source_date":"2026-09-01","image":"https://hartvaat.nl/global/img/4ae9c5687fce.webp","kennis":["https://hartvaat.nl/kennis/kleplijden/aortastenose/","https://hartvaat.nl/kennis/kleplijden/tavi-transcatheter-aortaklepimplantatie/"],"congress":"","summary_en":"A network meta-analysis of 31 studies (37,741 patients) compared transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with severe aortic stenosis. TAVR, particularly with balloon-expandable valves, demonstrated comparable short- and intermediate-term survival while significantly reducing 30-day stroke, major bleeding, acute kidney injury, and readmission rates, and shortening hospital stays by approximately four days. SAVR remained associated with lower rates of paravalvular regurgitation and permanent pacemaker implantation across all time horizons. These findings support platform-specific, individualized decision-making, positioning balloon-expandable TAVR as a safe and efficient alternative to surgery in low-risk patients.","created":"2026-08-07T00:50:01Z","updated":"2026-08-10T10:35:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een netwerkmeta-analyse van 31 studies (37.741 patiënten) vergeleek TAVR en chirurgische aortaklepvervanging (SAVR) bij laag-risico patiënten met ernstige aortastenose. TAVR, met name met ballon-expanderbare kleppen, leverde vergelijkbare kort- en middellangetermijnoverleving op, maar verlaagde aanzienlijk het risico op beroerte, bloedingen, acute nierinsufficiëntie en heropname binnen 30 dagen, en verkortte de ziekenhuisopname met ongeveer vier dagen. Chirurgische vervanging bleef superieur wat betreft minder paravaleculaire insufficiëntie en een lager risico op permanente pacemakerimplantatie. Deze bevindingen ondersteunen een platform-specifieke, individuele besluitvorming waarbij TAVR met ballon-expanderbare kleppen een veilige en efficiënte optie is voor laag-risico patiënten.","abstract_original":"PURPOSE: To compare the safety and efficacy of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in low-risk severe aortic stenosis, and to assess the differential impact of balloon-expandable (BE) and self-expanding (SE) valve platforms on clinical outcomes. METHODS: A systematic search across seven databases was performed through May 2024. Frequentist and Bayesian network meta-analyses were conducted across three pre-specified time horizons: 30 days, 1 to 2 years, and 3 or more years. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). Egger's regression testing and randomized controlled trial (RCT)-only sensitivity analyses were performed. RESULTS: Thirty-one studies (37,741 patients) were included. All TAVR types demonstrated comparable short-term and intermediate-term mortality to SAVR, with TAVR-BE ranking most favourably by Surface Under the Cumulative Ranking (SUCRA) (81.2% and 87.7%); these rankings should be interpreted alongside the non-significant effect estimates. In exploratory ≥3-year analyses (k=10 studies, consistent with RCT-only sensitivity analyses), TAVR-Mixed showed significantly higher mortality than SAVR (OR 1.963 [95% CI 1.620 to 2.378]; p<0.001), while TAVR-BE and TAVR-SE showed no significant difference. TAVR-BE significantly reduced 30-day rehospitalization (OR 0.625; p=0.007), stroke (OR 0.534; p=0.001), atrial fibrillation, acute kidney injury, and major bleeding versus SAVR. All TAVR platforms shortened hospital stay by approximately 4 days. SAVR was associated with significantly lower rates of paravalvular regurgitation and permanent pacemaker implantation at all time horizons. CONCLUSION: In low-risk severe aortic stenosis, TAVR, particularly with balloon-expandable valves, appears to offer comparable short-term and intermediate-term survival with superior procedural safety versus SAVR. In exploratory ≥3-year analyses, SAVR was associated with lower mortality specifically within the heterogeneous TAVR-Mixed cohort; TAVR-BE and TAVR-SE showed no significant mortality difference from SAVR at this horizon, underscoring the importance of platform-specific and individualised decision-making. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12055-026-02245-1."}