Clinical Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Pure Native Aortic Regurgitation: A Systematic Review and Meta-Analysis

Background: Aortic valve regurgitation is a common valvular heart disease. Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are the principal therapeutic modalities, while the comparative efficacy of these two approaches remains controversial. Methods: This systematic review and meta-analysis was prospectively registered on PROSPERO (registration number: CRD420261411339). We systematically searched Web of Science, PubMed, EMBASE, and the Cochrane Library databases for relevant studies from their inception to 26 July 2026. RevMan 5.4 software was used to conduct this analysis. Odds ratios (OR) with 95% confidence intervals (CI) were used to evaluate the outcomes. Results: We assessed in-hospital outcomes and post-discharge 30-day outcomes. The primary outcomes were length of hospital stay, perioperative complications, and valve condition. Secondary outcomes included all-cause mortality, cardiovascular mortality, new-onset atrial fibrillation (AF), and new permanent pacemaker implantation (PPI). Nine articles involving 28,811 patients were included. Compared with SAVR, TAVR reduced length of hospital stay [mean difference (MD) = −4.49, 95% confidence interval (CI): −4.98, −4.01, p < 0.00001, I2 = 80%], perioperative complications [Odds ratios (OR): 0.55, 95% CI: 0.50 to 0.60, p < 0.00001, I2 = 62%) and new-AF(OR: 0.50, 95% CI: 0.43 to 0.59, p < 0.00001 I2 = 30%). However, there was a significant increase in perivalvular leakage (OR: 17.13, 95% CI: 4.13 to 71.13, p < 0.0001 I2 = 29%) and new PPI (OR: 2.63, 95% CI: 2.13 to 3.25, p < 0.00001 I2 = 80%). There was no significant difference observed in all-cause mortality (OR: 0.91, 95% CI: 0.69–1.20, p = 0.49, I2 = 69%). Conclusions: Compared with SAVR, TAVR reduced length of hospital stay, perioperative complications, and new AF. However, it was associated with an increase in perivalvular leakage and new PPI. These findings suggest that TAVR may represent a better strategy for patients with pure native aortic regurgitation.