Transcatheter versus conventional surgery in patients with aortic stenosis requiring valve replacement

Abstract

Aortic stenosis is a conditions that restricts blood flow from the left ventricle through the aortic valve and is associated with high mortality, reaching up to 75% within the first three years if left untreated without valve replacement. The definitive management consists of aortic valve replacement, traditionally performed with conventional surgery and more recently, via transcatheter approach. This narrative review aims to compare transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with aortic stenosis, analyzing published evidence regarding their advantages, limitations, complications, reintervention rate and mortality. To this end, a literature search was conducted in PubMed, Scielo, and Google Scholar, including studies based on methodologic design, levels of evidence and clinical relevance, among them, meta-analyses, randomized clinical trials, clinical guidelines and narrative reviews in Spanish, English, and Portuguese, from both primary and secondary sources between 2015 and 2025. Evidence suggests that SAVR provides greater durability and lower reintervention rates, while TAVR offers important advantages in high-risk patients, such as lower short-term mortality and shorter hospital stays. Therefore, a comprehensive clinical assessment is essential to optimize the therapeutic decision-making.