Risk of Short-Term Stroke in Non-High-Risk Patients Undergoing Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Background: To compare the incidence of stroke at 1 and 2 years following transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), aiming to inform clinical decision-making regarding the safety and effectiveness of these interventions. Methods: A random-effects meta-analysis was conducted including 9 randomized controlled trials (RCTs) with a total of 9865 patients. The primary endpoint was the incidence of stroke at 1 and 2 years post-procedure. Results: At 1 year, TAVR was associated with a lower incidence of stroke compared with SAVR (odds ratio (OR), 0.77; 95% confidence interval (CI), 0.61–0.98; p = 0.03). No significant difference was observed at 2 years (OR, 0.87; 95% CI, 0.65–1.17; p = 0.37). Conclusions: TAVR significantly reduces the risk of stroke within 1 year post-procedure compared with SAVR; however, this effect was not maintained at 2 years. These findings highlight the early benefit of TAVR, while the long-term advantage requires further investigation. The PROSPERO Registration: This study has been registered with PROSPERO, registration number: CRD42025636191, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025636191.